Looking Outside the Pharmacy Silo to Determine the True Cost of Periop Pain Modalities

    A pilot program comparing opioid consumption and the cost per episode of care for 5 postoperative pain modalities following primary total joint arthroplasty (TJA) was presented at the annual meeting of the American Academy of Orthopaedic Surgeons in Las Vegas.

    By evaluating the entire episode of care, the researchers sought to determine whether the use of periarticular injection with liposomal bupivacaine could decrease costs per case sufficiently to justify the pharmacy expense compared with other modalities.

    They noted that the addition of new modalities for treating postoperative pain following TJA may prove to be beneficial, but often add significant expense to pharmacy budgets. Consideration should be given, they said, to the modalities beyond the pharmacy cost and evaluated in relation to the entire episode of care.

    The program was initiated at a large hospital system, and the study included 366 patients who underwent primary TJA. It analyzed 5 modalities:

    • Continuous femoral nerve blocks
    • Indwelling epidural anesthesia
    • Elastomeric pumps
    • Single-shot femoral/sciatic nerve blocks
    • Periarticular injection with liposomal bupivacaine

    Total opioid consumption in morphine equivalents and cost per episode of care (hospitalization for TJA) were evaluated.

    Liposomal bupivacaine resulted in a statistically significant reduction in opioid consumption compared with the other modalities (130.2 mg vs 110.4 mg, P=0.0035).

    Liposomal bupivacaine had a lower cost per episode of care (range of $130 to $702) than continuous nerve block, single-shot nerve blocks and elastomeric pumps. Indwelling epidural catheter (12-hour epidural and ropivacaine drip) was the only modality that resulted in a lower cost per episode ($169 to $192).

    The researchers concluded that, “While the addition of liposomal bupivacaine to hospital pharmacy may add cost to pharmacy budget, when looking outside the silo, liposomal bupivacaine significantly reduced opioid consumption and resulted in an overall decrease cost per episode of care for primary total hip and knee arthroplasty compared to other commonly used modalities.”


    Springer BD, Bear S, Christian EP. Thinking beyond hospital pharmacy silo analysis of perioperative pain modalities in total joint arthroplasty. Presented at: American Academy of Orthopaedic Surgeons (AAOS) 2015 Annual Meeting; March 24-28, 2015; Las Vegas, NV. Paper 672