Research shows opioid-free pain relief after total knee replacement surgery is a possibility

A total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. More than 767,000 TKAs are performed annually in the United States, and that number is expected to grow to 1.5 million additional procedures by 2030.¹As the rate of procedures increases, pain management continues to be a leading concern for patients.²

In the U.S., approximately 99 percent of surgical patients are prescribed post-surgical opioids³ and 53 percent of knee-replacement patients were still taking opioids six months after surgery, with an even higher incidence among those who also took opioids before surgery to manage chronic pain.⁴

A recent Phase 4 PILLAR Study about the use in total knee arthroplasty of EXPAREL^® (bupivacaine liposome injectable suspension)⁵, a non-opioid, long-lasting local analgesic targeted at the surgical site, underscores the importance of non-opioid pain management options that can reduce a patient’s exposure to opioids.

The PILLAR study demonstrated a reduction in opioid requirements and pain scores for patients using EXPAREL, and measured two key factors: the magnitude and duration of post-surgical pain relief, and associated impact on opioid consumption.⁵

During the study, 139 TKA patients were randomized into two groups. Seventy patients received surgical site injections of EXPAREL mixed with a local anesthetic, and 69 patients received a local anesthetic alone. Patients in both groups received identical oral pain management before and after surgery and had access to rescue opioids as needed.⁵

Patients in the EXPAREL group demonstrated a statistically significant decrease in total opioid consumption — 78 percent in the 48 hours following surgery. Patients also experienced a 13.6 percent reduction in pain scores between the 12 and 48 hours after surgery. In fact, 10 percent of patients in the EXPAREL group were opioid free through the first 72 hours following surgery compared to zero percent of patients who received a local anesthetic alone.⁵

Pain management after surgery has a significant impact on recovery.⁶ Pain is a personal experience and an informed conversation between doctor and patient can lead to better post-surgical pain management.

EXPAREL is indicated for administration into the surgical site to produce post-surgical analgesia.

Important Safety Information

EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies with EXPAREL, the most common side effects were nausea, constipation and vomiting.

EXPAREL is not recommended for use in patients younger than 18 years of age or in pregnant women.

Tell your healthcare professional if you have liver disease as this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body.

EXPAREL should not be injected into the spine, joints or veins.

Other local anesthetics should not be injected immediately after injecting EXPAREL; this may lead to an immediate release of the active ingredient in EXPAREL.

The active ingredient in EXPAREL can affect your:

• Nervous and cardiovascular system,
• May cause an allergic reaction,
• And/or if injected into your joints may cause damage to the joints.

Full Prescribing Information for EXPAREL is available at www.EXPAREL.com.

References:

¹GlobalData, Orthopedic Devices [Knee Reconstruction] Market, United States, 2009-2023, Absolute Units, 2017.
²Barlow T, Griffin D, Barlow D, Realpe A. Patients’ decision making in total knee arthroplasty: a systematic review of qualitative research. Bone Joint Res. 2015;4(10);163-169.
³Kessler ER, Shah M, Gruschkus SK, Raju A. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy. 2013;3(4)3:383-391.
4Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use following total knee and total hip arthroplasty. Pain. 2016; 157(6):1259-1265.
⁵Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2017:1-7. doi:10.1016/j.arth.2017.07.024.
⁶Barrington JW; Expert Working Group on Anesthesia & Orthopaedics. Critical issues in hip and knee replacement arthroplasty. Am J Ortho. 2014;43: S1-S16.

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