Infiltration Techniques for Local Infiltration Analgesia With Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion

Journal of Orthopaedic Trauma
Nirav H AminAnthony G Sanzone

Abstract

Liposomal bupivacaine (LB) has demonstrated efficacy in improving pain scores and reducing opioid consumption across a variety of surgical settings, including orthopaedic surgery. However, meticulous infiltration techniques combined with a multimodal approach are important to optimizing outcomes. A panel of 4 orthopaedic surgeons and 3 anesthesiologists convened on April 1, 2017, to discuss current practices and develop a consensus statement regarding local infiltration analgesia with LB for extracapsular and intracapsular hip fracture surgery, including LB infiltration techniques. Optimizing surgical outcomes with LB in hip fracture surgery requires an understanding of the neuroanatomy of the surgical site and the pharmacology of the drug. Meticulous infiltration technique is critical to achieve optimal results with LB given its viscosity and reduced diffusion compared with bupivacaine HCl. For extracapsular procedures, a total injection volume of 120 mL is recommended, whereas intracapsular procedures typically require a lower volume (∼80 mL). In both cases, infiltration is best achieved using a 22-gauge needle and applying a tracking and/or fanning technique. To ensure optimal placement, LB should be infiltrated using multip...Continue Reading

References

Feb 20, 2007·Injury·Ioannis S BenetosPanayotis N Soucacos
Aug 17, 2011·Annals of Internal Medicine·Ahmed M Abou-SettaC Allyson Jones
Sep 10, 2011·Journal of Orthopaedic Trauma·Christopher A BrownJames A Nunley
Mar 1, 2012·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Birthe GenthChristoph Von Schulze-Pellengahr
May 10, 2012·Journal of Pain Research·Sergio D BergeseKeith A Candiotti
Jan 11, 2013·The Journal of Bone and Joint Surgery. American Volume·Hyun KangEui-Chan Jang
Jan 18, 2014·Clinics in Colon and Rectal Surgery·Veerabhadram Garimella, Christina Cellini
Sep 25, 2014·BMC Musculoskeletal Disorders·Benjamin G DombJohn M Redmond
Jan 28, 2015·The Journal of the American Academy of Orthopaedic Surgeons·Karl C RobertsKaitlyn Sevarino
May 9, 2015·Injury·Anna Gaki LindestrandStig Ejdrup Andersen
Sep 4, 2015·Geriatric Orthopaedic Surgery & Rehabilitation·Alexander J BollingerTerrence J Endres
Sep 28, 2015·The Orthopedic Clinics of North America·John W BarringtonRoger H Emerson
Feb 14, 2016·The Journal of Arthroplasty·Stephen W YuRichard Iorio
Apr 23, 2016·Journal of Orthopaedic Trauma·Anthony G Sanzone
Sep 4, 2016·BMC Geriatrics·Suzanne M DyerUNKNOWN Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
Apr 14, 2017·JAMA Surgery·Chad M BrummettBrahmajee K Nallamothu

❮ Previous
Next ❯

Citations

Apr 3, 2020·Current Osteoporosis Reports·Hannah Elsevier, Lisa K Cannada

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.