Multimodal Pain Strategies Including Liposomal Bupivacaine for Isolated Acetabular Fracture Surgery

Journal of Orthopaedic Trauma
Michael J Langworthy, Anthony G Sanzone

Abstract

The incidence of isolated acetabular fractures has been increasing, particularly in older adult patients. These fractures can be debilitating and may require prolonged immobilization and/or complex surgical reconstruction. Liposomal bupivacaine (LB) is a prolonged-release form of bupivacaine demonstrated to be effective in orthopaedic surgery. Defining a multimodal pain management plan, which incorporates optimized techniques for use of LB in acetabular surgery, may improve outcomes for patients. Two orthopaedic surgeons specializing in orthopaedic traumatology discussed best practices for infiltration of LB and recommendations for perioperative use of LB plus other anesthetics/analgesics for isolated acetabular fracture surgery. Consensus techniques for isolated posterior and anterior acetabular fractures were developed. LB (266 mg/20 mL) should be expanded with 50 mL of bupivacaine HCl 0.25% and saline to a total volume of 120 or 300 mL for the posterior or anterior techniques, respectively. A 3.5-inch spinal needle is inserted tangentially, infiltrating 1 mL/cm into the fracture site, periosteum, muscle fascia, subcutaneous tissue, and skin. Patients receive acetaminophen, celecoxib, gabapentin, and opioids before surgery, a...Continue Reading

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Jan 11, 2018·Geriatric Orthopaedic Surgery & Rehabilitation·Nirav H AminHrayr G Basmajian

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Citations

Sep 15, 2021·European Journal of Orthopaedic Surgery & Traumatology : Orthopédie Traumatologie·Daniel J CunninghamMark J Gage

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