Does Local Soft Tissue Infiltration With a Liposomal Bupivacaine Cocktail Have a Synergistic Effect When Combined With Single-Shot Adductor Canal Peripheral Nerve Block in Knee Arthroplasty?


The purpose of this study was to determine if periarticular injection (PAI) with liposomal bupivacaine
cocktail has a synergistic effect on pain relief with a single-injection adductor canal block in knee arthroplasty. Three hundred thirty-three knee arthroplasties were divided into three groups. Group 1 received general anesthesia (GA) and liposomal bupivacaine PAI. Group 2 received GA, peripheral nerve block (PNB), and liposomal bupivacaine PAI. Group 3 received GA, PNB, and ‘‘plain’’ ropivacaine PAI. Remaining perioperative multimodal medications and therapies were identical. There were no statistically significant differences in average narcotic use between any groups on the day of surgery, postoperative day 1, or postoperative day 2. Group 3 had the lowest postoperative nausea. Group 2 had the least pruritis. The current study failed to demonstrate a decrease in narcotic consumption with the Combination of liposomal bupivacaine PAI and PNB. This study supports previous studies demonstrating that liposomal bupivacaine PAI provides similar outcomes to PNB. (Journal of Surgical Orthopaedic Advances 25(4):222–226, 2016) Key words: Exparel, knee arthroplasty, liposomal bupivacaine, multimodal pain, periarticular injection, peripheral nerve block

Zachary C. Lum, DO; Adolph V. Lombardi, Jr., MD, FACS; Jason Hurst, MD; Michael Morris, MD; and Keith Berend, MD