Pinnacle Orthopedics, Marietta, Georgia.
Joint Replacement Center of Texas, Baylor Medical Center Frisco, Plano, TX.
J Arthroplasty. 2019 May;34(5):882-886.e1. doi: 10.1016/j.arth.2018.12.026. Epub 2018 Dec 25.
Enhanced postoperative care pathways have shifted total knee arthroplasty (TKA) to outpatient and short-stay settings, placing greater emphasis on predischarge outcomes. In this study, we report prespecified secondary and tertiary end points of the PILLAR study within 24 hours after TKA in patients receiving local infiltration analgesia (LIA) with or without liposomal bupivacaine (LB).
Patients with knee osteoarthritis were randomized 1:1 to receive LIA with LB 266 mg/20 mL admixed with bupivacaine HCl 0.5% 20 mL (n = 70) or bupivacaine HCl alone (n = 69). End points (0-24 hours postsurgery) were proportion of opioid-free patients, opioid consumption, areas under the curve of visual analog scale pain intensity scores, patient satisfaction, discharge readiness, and ambulation. Safety was also assessed.
Patients receiving LIA with LB were 16% less likely to require opioid rescue within 24 hours postsurgery (17.1% vs 1.4%; relative risk, 0.085; 95% confidence interval, 0.011-0.633). LIA with LB was associated with a 91% reduction in opioid consumption (P = .0009) and 19% reduction in pain intensity (P = .0142). Significantly more patients receiving LB were discharge ready (42.9% vs 27.5%; P = .0449) and satisfied with pain treatment (84.6% vs 69.2%; P = .0306). A numerically lower but not significantly different proportion achieved steady gait/no dizziness with LIA with LB (42.9% vs 52.2%). Adverse event incidence was similar between groups.
LIA with LB 266 mg plus bupivacaine HCl significantly reduced opioid requirements and pain intensity and significantly improved discharge readiness and satisfaction 0-24 hours after TKA compared with bupivacaine HCl alone. These findings support the use of LIA with LB for TKA when early discharge is the goal.
增强型术后护理路径已将全膝关节置换术（TKA）转移到门诊和短期住院环境，更加注重出院前的结果。在这项研究中，我们报告了接受局部浸润镇痛（LIA）加或不加脂质体布比卡因（LB）的 TKA 患者在术后 24 小时内预先指定的 PILLAR 研究的次要和次要终点。
膝关节骨关节炎患者以 1:1 的比例随机分为两组，一组接受 LIA 加 LB 266mg/20ml 与布比卡因 HCl 0.5%20ml 混合（n=70），另一组接受布比卡因 HCl 单独治疗（n=69）。终点（术后 0-24 小时）为无阿片类药物患者的比例、阿片类药物消耗、视觉模拟量表疼痛强度评分曲线下面积、患者满意度、出院准备和活动能力。还评估了安全性。
接受 LIA 加 LB 的患者术后 24 小时内需要阿片类药物解救的可能性低 16%（17.1% vs 1.4%；相对风险，0.085；95%置信区间，0.011-0.633）。LIA 加 LB 与阿片类药物消耗减少 91%（P=0.0009）和疼痛强度降低 19%（P=0.0142）相关。接受 LB 的患者有更多的人准备出院（42.9% vs 27.5%；P=0.0449），对疼痛治疗更满意（84.6% vs 69.2%；P=0.0306）。接受 LIA 加 LB 的患者达到稳定步态/无头晕的比例略低但无统计学差异（42.9% vs 52.2%）。两组的不良事件发生率相似。
与单独使用布比卡因 HCl 相比，LIA 加 LB 266mg 加布比卡因 HCl 可显著降低 TKA 术后 0-24 小时的阿片类药物需求和疼痛强度，并显著提高出院准备和满意度。这些发现支持在早期出院为目标时使用 LIA 加 LB 进行 TKA。
