Abstract
BACKGROUND: We compared early postoperative pain levels and rescue opioids between conventional bupivacaine-based periarticular injections (PAIs), a new extended-release (ER) solution comprised of bupivacaine and meloxicam, and a combination of both. METHODS: A 40-week retrospective review was conducted of all elective, primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases from 2 surgeons. Both surgeons utilized an intraoperative PAI during the first 20 weeks, which was substituted for the ER analgesic when it became available on formulary. Surgeon 1 used it in isolation and Surgeon 2 used it in combination with the PAI, albeit at a smaller dose, during the latter 20 weeks. Numeric Rating Scale Pain Intensity Scores and total morphine milligram equivalents (MMEs) were compared within surgeon cohorts before and after their respective shift in intraoperative analgesic practice. RESULTS: Pain levels and MMEs were significantly higher with the ER analgesic alone vs PAI alone in both Surgeon 1's THA (P = .008 and P = .020) and TKA (P = .005 and P = .024) cohorts. Pain levels and MMEs were comparable when the ER analgesic was used in combination with PAI vs PAI alone in both Surgeon 2's THA (P = .360 and P = .236) and TKA (P = 1.0 and P = .177) cohorts. CONCLUSIONS: The ER analgesic used in isolation provided inferior pain control in the immediate postoperative period. When using ER analgesics, we recommend adding a faster-acting PAI to optimize early pain management and limit rescue opioid use. LEVEL OF EVIDENCE: Level III.