Liposomal vs. Standard Bupivacaine in Adductor Canal Catheters After Knee Arthroplasty: A RCT

Liposomal Bupivacaine versus Bupivacaine in Adductor Canal catheter After Total Knee Arthroplasty with different Postoperative Outcomes: A Randomized Controlled Trial.

This study compares the use of liposomal bupivacaine (Exparel) versus Bupivacaine in adductor canal catheter after total knee arthroplasties (TKAs).

From the months of October 2023to March 2024, 70 patients undergoing unilateral primary TKA were asked to participate in this prospective, double-blinded randomized controlled trial. Each patient received an Adductor canal catheter and iPACK block utilizing Bupivacaine 0.25% (10 ml). Then patients were additionally randomized to receive an injection in the adductor catheter with Exparel or Bupivacaine 0.5% (10 ml) as pain management postoperatively. For each patient, demographic information, inpatient hospital information, postoperative opioid use, and numerical Pain Score were registered.

Overall, 70 patients were included (35 in each group). The Exparel group had the same hospital length of stay compared to the Control group (4 nights). Patients in the Exparel group reported an increased amount of Numerical Rating Scale pain score at postoperative timepoints. These patients also used a higher consumption of inpatient opioids (40.9 vs 47.3, P = .04)

Exparel injection in adductor canal catheter led to increase in pain levels, same hospital lengths of stay and increase inpatient opioid consumption. Exparel used in adductor catheter after TKA showed diverse and unexpected results in controlling postoperative pain and decrease length of stay.