Reducing Opioid Use after Total Hip Arthroplasty

    The opioid epidemic in the US has put the use of these drugs to control pain following surgical procedures under intense scrutiny.

    At the same time, emphasis on patient satisfaction with pain management is an increasingly important component of reimbursement for joint replacementg surgery in bundled payment models.

    To reduce opioid use while still providing post-surgical pain control, orthopaedic surgeons have adopted multimodal pain managment protocols over the past few years. One facet of those protocols in many institutions is intra-articular injection of anesthetic/analgesic agents during the joint replacement procedure.

    At ICJR’s Pan Pacific Orthopaedic Congress, Christopher N. Johnson, DO, from McLaren Macomb, Mt. Clemens, Michigan, reported on a retrospective study comparing opioid consumption and pain scores before and after the addition of intra-articular injection of liposomal bupivacaine to his institution’s pain management protocol.

    The study included 170 patients who had undergone primary total hip arthroplasty between January 2014 and October 2014, with 85 patients in the liposomal bupivacaine group and 85 patients in the non-liposomal bupivacaine group.

    Dr. Johnson reported an overall 61% reduction in total opioid consumption in the liposomal bupivacaine group compared with the non-liposomal bupivacaine group (4,366 mg vs. 11,157.5 mg, respectively; P< 0.0001). Note that total opioid consumption was converted to a hydrocodone equivalent dose to allow for analysis.

    The average visual analogue pain scores were 1.9 for the liposomal bupivacaine group and 3.5 for the non-liposomal bupivacaine group.

    In addition, patients in the liposomal bupivacaine group were discharged on a lower dose of opioids than were patients in the non-liposomal bupivacaine group.

    Click the image above to hear Dr. Johnson’s comments on the study findings and implications.


    Johnson CN, Curl J, Ajluni A. Wound infiltration with liposomal bupivacaine reduces narcotic consumption in patients undergoing total hip arthroplasty. Presented at the 2nd Annual Pan Pacific Orthopaedic Congress, July 12-15, 2015, Kona, Hawaii.