Key Takeaways & Executive Findings
- •• Single-dose liposomal bupivacaine provides comparable analgesia to continuous ropivacaine infusion for 72 hours after total knee arthroplasty. • Single-dose liposomal bupivacaine significantly reduces procedure time (6.1 vs 20.3 minutes) and cost (saving 132 RMB per patient). • No significant differences in pain scores, morphine consumption, hospital stay, or patient satisfaction between the two techniques. • Single-dose liposomal bupivacaine avoids catheter-related complications and is a more efficient, cost-effective alternative.
Abstract
BACKGROUND: Effective analgesia after total knee arthroplasty is crucial for rehabilitation, and adductor canal block is a common method. Traditional single injection of local anesthetic has limited analgesic duration, while continuous catheter infusion is complex and costly. OBJECTIVE: To compare the efficacy and safety of single-dose liposomal bupivacaine versus continuous catheter infusion of ropivacaine for adductor canal block analgesia after total knee arthroplasty. METHODS: Eighty patients undergoing primary unilateral knee arthroplasty at Gaoyou People's Hospital from March 2024 to February 2025 were randomly divided into liposomal bupivacaine group and continuous catheter infusion group. The liposomal bupivacaine group received a single adductor canal block with 133 mg (10 mL) liposomal bupivacaine mixed with 5 mL of 0.75% ropivacaine. The continuous catheter infusion group received an adductor canal catheter with 0.25% ropivacaine via a pump (load 10 mL, infusion rate 6 mL/h). Pain scores at different time points, pain-free time, morphine rescue dose, and walking distance were compared to assess analgesic efficacy; complications were observed for safety. Operation time, cost, patient satisfaction, and hospital stay were also compared. RESULTS AND CONCLUSION: (1) At 6, 12, 24, 48, and 72 h postoperatively, there were no significant differences in resting and movement pain scores between groups (P > 0.05). Pain-free time was 19 h in the liposomal bupivacaine group and 22 h in the continuous infusion group (P > 0.05). (2) At 72 h, morphine rescue dose was 78.6 mg morphine equivalents in the liposomal bupivacaine group and 80.5 mg in the continuous infusion group (P > 0.05). (3) Operation time was significantly shorter in the liposomal bupivacaine group (6.1±1.4 min vs. 20.3±1.2 min, P < 0.05). (4) Patient satisfaction, hospital stay, and walking ability showed no significant differences (P > 0.05). (5) One case of transient femoral nerve palsy occurred in the continuous infusion group at 6 h postoperatively, resolving spontaneously. Each patient in the liposomal bupivacaine group saved 132 RMB in analgesic costs. (6) Within 72 h after total knee arthroplasty, single-dose liposomal bupivacaine and continuous ropivacaine infusion showed no differences in analgesic scores, pain-free time, morphine rescue dose, hospital stay, satisfaction, or walking ability, but single-dose liposomal bupivacaine was more convenient, saving time and cost.
1. Introduction
Although total knee arthroplasty significantly restores joint function, postoperative acute pain remains a critical clinical issue affecting early rehabilitation, and its management poses major challenges [1-3]. Among multimodal analgesic strategies, adductor canal block has replaced traditional femoral nerve block as the 'gold standard' for regional analgesia after total knee arthroplasty due to its unique advantage of preserving quadriceps muscle strength [4-6]. However, its clinical application is limited by the short duration of single-shot conventional local anesthetics, while continuous catheter infusion, although prolonging analgesia, presents practical issues such as catheter displacement risk, increased nursing burden, and procedural complexity [7-9].
Liposomal bupivacaine, a novel slow-release local anesthetic system, offers a theoretical solution to the dilemma between analgesic duration and procedural complexity. However, existing clinical evidence has not fully validated the comprehensive value of this novel extended-release formulation in adductor canal block, particularly in comparison with traditional continuous catheter techniques, regarding the sustainability of analgesic effect, functional recovery, safety, and health economics. This study aims to fill this gap by comparing the efficacy and safety of single-dose liposomal bupivacaine versus continuous ropivacaine infusion for adductor canal block after total knee arthroplasty.
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LIU Chenglong, WEI Shanwen, LI Di, ZOU Mingming, MA Yanxia (2026). Single-dose liposomal bupivacaine versus continuous ropivacaine infusion for adductor canal block analgesia after total knee arthroplasty. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21392
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Frequently Asked Questions
What is liposomal bupivacaine?
Liposomal bupivacaine is a novel long-acting local anesthetic that uses multivesicular liposome encapsulation to slowly release bupivacaine at the injection site, providing analgesia for up to 72 hours, compared to 4-8 hours for traditional bupivacaine. It is primarily used for postoperative local infiltration analgesia, reducing opioid consumption and related side effects.
What is an adductor canal block?
An adductor canal block is an ultrasound-guided regional anesthesia technique that targets the saphenous nerve within the adductor canal to provide analgesia for knee pain while preserving quadriceps muscle strength, facilitating early mobilization. It is commonly used for postoperative pain control after total knee arthroplasty and anterior cruciate ligament reconstruction.
How does single-dose liposomal bupivacaine compare to continuous catheter infusion for adductor canal block?
In this study, single-dose liposomal bupivacaine provided comparable analgesia to continuous ropivacaine infusion over 72 hours, with no significant differences in pain scores, morphine consumption, hospital stay, or patient satisfaction. However, the single-dose technique significantly reduced procedure time and cost, and avoided catheter-related complications.
What are the advantages of single-dose liposomal bupivacaine over continuous catheter infusion?
Single-dose liposomal bupivacaine offers greater convenience, shorter procedure time (about one-third), lower cost (saving 132 RMB per patient), and eliminates risks associated with catheter placement and maintenance, such as infection or displacement.
Is single-dose liposomal bupivacaine as effective as continuous infusion for pain control after knee replacement?
Yes, the study found no significant differences in pain scores, pain-free time, or morphine rescue dose between the two techniques within 72 hours postoperatively, indicating that single-dose liposomal bupivacaine is equally effective for early postoperative pain management.
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