Efficacy of Liposomal Bupivacaine in Regional Nerve Blocks for the Below-Knee Amputation: A Retrospective Cohort Study

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Introduction: Below-knee amputation (BKA) patients often struggle with postoperative pain as well as phantom limb pain. As excessive postoperative opioid use increases the risk of dependence, hyperalgesia, and decreased quality of life, regional nerve blocks using liposomal bupivacaine (LB) offer the promise of providing postoperative pain control while minimizing the need for opioids. This study aims to evaluate whether the use of LB in regional nerve blocks for BKA surgery prolongs postoperative analgesia compared with conventional local anesthetic blocks and no nerve blocks. Methods: A retrospective cohort study was conducted on patients who underwent a BKA at a large community hospital system from 2019 to 2024, placing patients into three arms: ultrasound-guided nerve block with LB, ultrasound-guided nerve block with local anesthetic only, and no nerve block. The primary outcome was daily average oral morphine equivalent (OME) use within the first 48 hours postoperatively. The secondary outcome was average pain scores in the first 48 hours postoperatively. Results: The use of LB in nerve blocks for BKA surgery led to a statistically significant difference in pain scores when compared with the other two groups. Discussion: The much higher cost of LB compared to local anesthetic becomes a consideration in the context of less pain but similar opioid use.