#36155 The use of exparel in knee arthroplasty: a service improvement project

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims

Total Knee Arthroplasty (TKA) remains a painful procedure, requiring a multi-modal analgesic approach. There is a push for day case surgery due to the associated poorer mortality and morbidity that comes with increased length of stay; as well as the greater cost. To facilitate day case TKA, long- acting analgesic strategies such as perineural catheters and modified release opioids are looked upon. Exparel is a long-acting liposomal bupivacaine that has the potential to take the place of these aforementioned techniques. As part of a service improvement project we introduced Exparel in patients receiving a TKA and assessed impact upon length of stay.

Methods

At our hospital patients undergoing elective knee arthroplasty are normally given spinal or general anaesthetic plus a combination of blocks; sub- sartorial +/- anterior-cutaneous nerves of the thigh +/- iPACK, adductor hiatus blocks or posterior surgical infiltration. We substituted 20mls of levobupivacaine for 20mls of Exparel. We then looked at post-operative length of stay.

Results

10 patients undergoing elective total knee arthroplasty received levobupivacaine/Exparel mixture and had an average length of stay of 1.8 days. This is in contrast to our Model Hospital data for 2022/23 which shows an average length of stay of 3.4 days.

Conclusions

The addition of Exparel reduced our average length of stay which is in keeping with a study by Malige et al. We plan to continue the TKA service improvement project in an attempt to find the best analgesic strategy that facilitates same day discharge.

Attachment

Exparel – HRA decision tool – not research.pdf