Effects of Liposomal Bupivacaine With Adductor Canal Block on Pain and Functional Outcomes in Patients Undergoing Total Knee Arthroplasty

Background: Liposomal bupivacaine (LB) has an extended duration of action compared to bupivacaine and may allow patients to reach physical therapy (PT) goals faster than traditional methods. Objective: To determine the effect of a periarticular LB mixture with adductor canal blockade (ACB) on postoperative opioid requirements, pain scores, and functional outcomes in patients undergoing primary unilateral total knee arthroplasty. Methods: A retrospective chart review was performed; 86 patients received the LB mixture + ACB, and 86 historical controls received nonliposomal bupivacaine and femoral nerve block (FNB). Results: There was no effect of group on mean postoperative pain scores (P = 0.144). There was an effect of group on equivalent morphine dose (P = 0.008). Pain scores and morphine doses changed over time in both groups, but there was no time-group interaction. Compared with controls, patients in the LB mixture group were more likely to require minimal assistance or better when going from a sitting to a standing position by postoperative day 1 (POD; 99% vs 81%, P = 0.0001) and POD 2 (90% vs 77%, P = 0.0212). There were no differences between groups with regard to discharge disposition or safety outcomes. Use did not affect LOS for patients discharged to an extended care facility but did reduce LOS for those discharged home. Conclusions: The LB mixture was effective in reducing opioid use and improving functional outcomes compared with historical controls.