88,830 total knee replacements performed between 2013 and 2016.
"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," says Stavros G. Memtsoudis, MD,
PhD, senior study author and director of critical care services in the
department of anesthesiology at the Hospital for Special Surgery.
The retrospective analysis was published in May in the Online First
edition of Anesthesiology (osmag.net/FR9qjK). Researchers found the
addition of Exparel was not associated with a decrease in patients' risk
for opioid-related complications including those affecting the respira-
tory, gastrointestinal and central nervous system. Further, no clinically
relevant decrease in inpatient opioid prescriptions, length of hospital
stay and no reduction in cost of hospitalization were seen.
"The routine use of liposomal bupivacaine should be carefully exam-
ined, especially given its relatively high cost. It does not seem to be
the silver bullet physicians have been hoping for," says Dr.
Memtsoudis.
Pacira, the manufacturer of Exparel, sees more than a few problems
with the researchers' findings. Among other things, Pacira says there
was a statistically significant 9.3% decrease in opioid use in patients
who received Exparel, but the "authors arbitrarily proposed a mini-
mum of 15% opioid reduction as being clinically meaningful." Also,
there was a statistically significant 8.8% drop in the length of stay for
the Exparel group but, again, "the authors arbitrarily deemed this not
clinically meaningful."
OSM
9 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 8
