Iorio Richard
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Medical Center, New York, NY.
Am J Orthop (Belle Mead NJ). 2016 Nov/Dec;45(7):S13-S17.
Multimodal pain control strategies are crucial in reducing opioid use and delivering effective pain management to facilitate improved surgical outcomes. The utility of liposomal bupivacaine in enabling effective pain control in multimodal strategies has been demonstrated in several studies, but others have found the value of liposomal bupivacaine in such approaches to be insignificant. At New York University Langone Medical Center, liposomal bupivacaine injection and femoral nerve block were compared in their delivery of efficacious and cost-effective multimodal analgesia among patients undergoing total joint arthroplasty (TJA). Retrospective analysis revealed that including liposomal bupivacaine in a multimodal pain control protocol for TJA resulted in improved quality and efficiency metrics, decreased narcotic use, and faster mobilization, all relative to femoral nerve block, and without a significant increase in admission costs. In addition, liposomal bupivacaine use was associated with elimination of the need for patient-controlled analgesia in TJA. Thus, at Langone Medical Center, the introduction of liposomal bupivacaine to TJA has been instrumental in achieving adequate pain control, delivering high-level quality of care, and controlling costs.
多模式疼痛控制策略对于减少阿片类药物的使用以及提供有效的疼痛管理以促进手术效果的改善至关重要。多项研究已证明脂质体布比卡因在多模式策略中实现有效疼痛控制的效用，但也有其他研究发现脂质体布比卡因在此类方法中的价值微不足道。在纽约大学朗格尼医学中心，对接受全关节置换术（TJA）的患者，比较了脂质体布比卡因注射和股神经阻滞在提供有效且具成本效益的多模式镇痛方面的效果。回顾性分析显示，在TJA的多模式疼痛控制方案中加入脂质体布比卡因，相对于股神经阻滞，可提高质量和效率指标，减少麻醉药物使用，并加快活动能力恢复，且入院成本无显著增加。此外，使用脂质体布比卡因可消除TJA中患者自控镇痛的需求。因此，在朗格尼医学中心，将脂质体布比卡因引入TJA有助于实现充分的疼痛控制、提供高水平的医疗护理并控制成本。
