Evaluating Perioperative Pain Control in Patients Receiving Regional Liposomal Bupivacaine Blocks Following Foot and Ankle Surgery

A retrospective analysis did not show any significant difference in opioid refills between patients receiving liposomal bupivacaine (LB) and those receiving plain bupivacaine or ropivacaine (PBR) following foot and ankle surgery. The study results indicated, however, that LB was associated with lower initial opioid dosing.

The study, which was presented at the American College of Foot and Ankle Surgeons Scientific Conference in Phoenix, AZ, aimed to determine whether LB provided superior perioperative pain control in foot and ankle surgery compared with PBR, given the increasing emphasis on opioid stewardship and multimodal analgesia. With the potential for LB to provide prolonged analgesic effects, the researchers sought to evaluate whether its use could reduce opioid consumption postoperatively.

To do this, Loitz and colleagues retrospectively studied 17,624 patients 18 years of age or older who underwent foot and ankle surgery at Kaiser Permanente Northern California between January 2018 and June 2021. The researchers examined whether perioperative pain management outcomes differed between patients receiving regional LB blocks (n = 254) and those receiving PBR (n = 17,370). Chi-square and Wilcoxon rank sum tests were used to compare categorical and continuous variables, respectively. Logistic regression was performed to assess the odds of requiring an opioid refill within 5 to 30 days postoperatively among those receiving LB versus PBR.

The analysis found that patients receiving LB initially appeared to have higher odds of requiring an opioid refill within 5 to 30 days postoperatively (odds ratio [OR] = 1.50; 95% CI, 1.14-1.97). However, after adjusting for confounders, the odds were no longer increased (adjusted OR = 1.00; 95% CI, 0.75-1.33). The researchers found no significant difference between groups in the total number of opioid refills dispensed (P = .97) or in average morphine milligram equivalent (MME) per day for refills (P = .82). Patients in the LB group did, however, receive a significantly lower average MME per day in their initial opioid prescription compared with those receiving PBR (P = .01).

A potential limitation of the study included the relatively small sample size of the LB cohort and the retrospective design, which may introduce confounding factors.

“The LB group was noted to have no statistically significant difference in refills, while reporting a lower average MME per day for index opioid prescription,” the authors concluded. “Further studies should include larger sample sizes to evaluate the true efficacy of LB.”

Reference
Loitz J, Brown MD, Dang K, Sibal J, Byrd A, Sellenriek SD. Evaluating improvements in perioperative pain management in foot and ankle surgery with the use of regional liposomal bupivacaine blocks. Presented at: American College of Foot and Ankle Surgeons Scientific Conference; March 27-30, 2025; Phoenix, AZ. Accessed March 17, 2025. https://imis.acfas.org/ACFAS2025/ACFAS2025/Abstracts.aspx?hkey=5209f2e8-69fc-4935-8823-799c8f5c2922.