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Local Anesthetic Fails to Curb In-Hospital Opioid Use

News  |  By John Commins  
   May 22, 2018

Despite the dramatic rise in the use of the use of liposomal bupivacaine, the local anesthetic was not associated with a decreased risk in patient opioid-related complications.

A sweeping review of the use of liposomal bupivacaine found no correlation with reduced in-hospital opioid prescriptions or opioid-related complications in patients, according to a study in Anesthesiology.

The local anesthetic is injected into tissues surrounding the surgical wound, and is designed to provide pain control for up to three days, with the hope of reducing the need for opioids.

"When we tested this hypothesis in a real-world setting where state of the art pain procedures such as peripheral nerve blocks were used, we were unable to show benefit," senior author Stavros G. Memtsoudis, MD, said in remarks accompanying the study.

"Local anesthesia is one mode that has been proposed as being part of a multimodal approach to reducing opioid consumption. But we found that adding liposomal bupivacaine to the mix did not add significant benefit," said Memtsoudis, director of critical care services in the Department of Anesthesiology at the Hospital for Special Surgery in New York.

The study looked at data from 88,830 total knee replacements performed between 2013 and 2016 with a peripheral nerve block. One group had a peripheral nerve block and general anesthesia, and another group had a peripheral nerve block and regional anesthesia.

Liposomal bupivacaine was used with a peripheral nerve block in 21% (18,817) of patients. Between 2013 and 2016, the use of liposomal bupivacaine increased from 7% to 26%.

The research showed that liposomal bupivacaine was not associated with a decrease in patients' risk for opioid-related complications including those affecting the respiratory, gastrointestinal and central nervous system. In addition, no clinically relevant decrease in inpatient opioid prescriptions, length of hospital stay, and no reduction in cost of hospitalization was seen.

"It does not seem to be the silver bullet physicians have been hoping for," Memtsoudis said. "We also need to look for other ways to try to combat the opioid crisis, including trying to change physician and patient behavior and expectations. We shouldn't necessarily look at a pharmacological solution for everything."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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