Technique for Periarticular Local Infiltrative Anesthesia Delivery Using Liposomal Bupivacaine in Total Knee Arthroplasty


Postoperative pain control after total knee arthroplasty is a major contributing factor to patient
satisfaction, rehabilitation, and length of stay. Current clinical practice guidelines recommend a
multimodal pain management protocol, including the use of regional anesthesia. Periarticular injection
(PAI) has been shown to provide excellent pain relief after total knee arthroplasty. Recently, liposomal
bupivacaine has been introduced as a long-acting alternative to traditional local anesthetics, such
as bupivacaine or ropivacaine. Liposomal bupivacaine is a sustained-release preparation designed to
provide local analgesia up to 72 hours after initial application. The efficacy of PAI relies significantly on a
meticulous, systematic injection technique. This article details recommendations for solution preparation
and injection during total knee arthroplasty on the basis of the experience of a high-volume orthopaedic
reconstruction service. (Journal of Surgical Orthopaedic Advances 24(4):263–266, 2015)

Key words: Exparel, liposomal bupivacaine, multimodal analgesia, periarticular injection, total knee

Jacob O. Connelly, MD; Paul K. Edwards, MD; Simon C. Mears, MD, PhD; C. Lowry Barnes, MD