Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial.

Kevin K Kang,Lucas Voyvodic,Daniel Komlos,Samuel Swiggett,Mitchell K Ng
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Abstract

BACKGROUND Liposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty. METHODS This was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy. RESULTS No significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82). CONCLUSIONS The results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
脂质体布比卡因不会减轻接受半关节成形术治疗的股骨颈囊内骨折患者的术后疼痛:HEAT--一项随机对照试验。
背景脂质体布比卡因(LB)是一种长效局麻药,开发用于外科手术环境,以帮助控制术后疼痛。本研究的目的是评估 LB 对接受髋关节半置换术治疗的囊内髋部骨折患者术后疼痛、功能和总体住院过程的影响。方法这是一项单中心、随机前瞻性双盲研究,研究对象为 2018 年至 2022 年接受髋关节半置换术治疗的 50 例孤立性股骨颈囊内骨折患者。研究组由 25 名接受术中 LB 和盐酸布比卡因注射治疗的患者组成,对照组由 25 名仅接受术中盐酸布比卡因注射治疗的患者组成。主要结果为疼痛视觉模拟量表(VAS)评分、吗啡毫克当量(MME)总量、谵妄和接受物理治疗后的活动时间。最值得注意的是,研究组和对照组在术后平均疼痛评分(VAS,2.26 对 2.7;P = 0.34)、术后使用的 MME 总量(11.73 对 9.98 MME;P = 0.71)和术后出院天数(4.00 对 3.88 天;P = 0.82)方面没有差异。结论我们的研究结果表明,使用 LB 与股骨颈骨折髋关节半关节置换术后疼痛或功能的显著改善或住院时间的缩短无关。考虑到枸橼酸髋关节置换术的成本高于标准术后止痛方式,在老年髋部骨折中使用枸橼酸髋关节置换术值得商榷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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