Minhaj Abdus-Samad Syed, Skipper Ashley Marie, Murphy Mckenna
Unity Hospital, Rochester, NY, USA.
Hosp Pharm. 2021 Dec;56(6):792-796. doi: 10.1177/0018578720965427. Epub 2020 Oct 20.
Geriatric patients receiving total knee arthroplasty (TKA) are found to have similar postoperative complications, functional scores, and perioperative mortality, as compared to younger patients. Conversely, geriatric patients often have longer lengths of stay. Periarticular injection (PAI) of liposomal bupivacaine (LB) as part of the multimodal pain management strategy is thought to improve recovery, however, mixed comparative efficacy data exists for its use in TKA.2-5. A retrospective, chart review was conducted at a 287-bed community teaching hospital. Orthopedic surgical patients who received an infiltration with liposomal bupivacaine versus bupivacaine HCl for unilateral TKA were compared. Patients identified in the electronic medical record by Diagnosis Related Group (DRG) 470-major joint replacement or reattachment of lower extremity without major complication or comorbidity codes were utilized. Patients who meet the following criteria were included: age 65 and older who underwent a TKA between 8/1/2018 to 7/31/2019 were discharged to home. Patients who have contraindications or hypersensitivity to bupivacaine formulations or a history of opioid dependence were excluded. The primary outcome is to identify whether patients who received an infiltration with liposomal bupivacaine had a lower total opioid consumption during their hospital stay. A total of 114 patients who had a DRG 470 code and were above the age of 65 years were studied. There was no statistically significant difference in mean total opioid consumption (oral morphine equivalents) between the bupivacaine HCl (n = 25) and liposomal groups (n = 85) respectively, 93.76 versus 83.72 mg; = .569. In addition, patients in both groups had similar lengths of hospital stay, 2.5 versus 3 days; = .529 and mean pain scores until discharge 3.7 versus 4.34 on VAS; = .305. The results of this drug utilization evaluation do not support a strong clinical advantage with local infiltration of liposomal bupivacaine over bupivacaine HCl in geriatric patients undergoing primary TKA surgery at this institution. There was not a statistically significant difference in mean total opioid consumption between the 2 groups. Additionally, the use of non-opioid analgesics, mean pain scores, and hospital lengths of stay were similar in both groups.
与年轻患者相比，接受全膝关节置换术（TKA）的老年患者术后并发症、功能评分和围手术期死亡率相似。相反，老年患者的住院时间往往更长。作为多模式疼痛管理策略的一部分，关节周围注射（PAI）脂质体布比卡因（LB）被认为可以促进恢复，然而，关于其在TKA中使用的比较疗效数据不一。2-5。在一家拥有287张床位的社区教学医院进行了一项回顾性图表审查。比较了接受脂质体布比卡因与盐酸布比卡因浸润用于单侧TKA的骨科手术患者。利用诊断相关组（DRG）470（主要关节置换或下肢再植，无重大并发症或合并症编码）在电子病历中识别出的患者。符合以下标准的患者被纳入：2018年8月1日至2019年7月31日期间接受TKA手术、年龄在65岁及以上且出院回家的患者。对布比卡因制剂有禁忌症或过敏反应或有阿片类药物依赖史的患者被排除。主要结果是确定接受脂质体布比卡因浸润的患者在住院期间的总阿片类药物消耗量是否更低。共研究了114例DRG编码为470且年龄在65岁以上的患者。盐酸布比卡因组（n = 25）和脂质体组（n = 85）的平均总阿片类药物消耗量（口服吗啡当量）分别为93.76毫克和83.72毫克，无统计学显著差异；P = 0.569。此外，两组患者的住院时间相似，分别为2.5天和3天；P = 0.529，出院时的平均疼痛评分在视觉模拟量表（VAS）上分别为3.7和4.34；P = 0.305。该药物利用评估的结果不支持在该机构接受初次TKA手术的老年患者中，脂质体布比卡因局部浸润比盐酸布比卡因具有明显的临床优势。两组之间的平均总阿片类药物消耗量没有统计学显著差异。此外，两组患者使用非阿片类镇痛药的情况、平均疼痛评分和住院时间相似。
