Single-Shot Liposomal Bupivacaine is a Safe and Effective Alternative to Continuous Catheter-Based Analgesia For Postoperative Pain Management of Foot and Ankle Surgery

Abstract

Category: Other, Other

Keywords: Peripheral Nerve Block (PNB), Ankle Block, Regional Anesthesia

Introduction/Purpose: Postoperative pain management is critical in foot and ankle surgery. Traditional opioid-based analgesia poses risks of dependency, and there is growing interest in opioid-sparing strategies, such as regional anesthesia. Liposomal bupivacaine (Exparel) has emerged as a promising alternative to continuous catheter-based analgesia. However, high-quality comparative studies for foot and ankle surgery remain limited. This study aims to compare the efficacy and safety of single-shot liposomal bupivacaine versus continuous catheter-based analgesia in managing postoperative pain in foot and ankle surgery.

Methods: This retrospective analysis evaluated patients who underwent foot and ankle surgery from January 2023 to December 2024. Two cohorts were compared: the Catheter group, receiving continuous peripheral nerve catheter-based analgesia, and the Exparel group, receiving a single-shot liposomal bupivacaine peripheral nerve block. Data collected included demographics, postoperative opioid consumption, and complication rates. Statistical analyses were performed using independent samples t-tests for continuous variables and chi-squared tests for categorical data.

Results: A total of 404 patients were analyzed (203 in the Catheter group, 201 in the Exparel group). The Exparel group had significantly lower opioid consumption across the first six postoperative days compared to the Catheter group (p < 0.001), with no significant difference in opioid consumption on day 7 (p = 0.834). The complication rate in the Catheter group was significantly higher (22.17%) due to catheter-related issues (leakage, dislodgement, paresthesias), whereas no complications were observed in the Exparel group (p < 0.001).

Conclusion: Single-shot liposomal bupivacaine offers effective postoperative pain relief with fewer complications compared to continuous catheter-based analgesia in foot and ankle surgery. The findings support its use as an opioid-sparing, cost-effective, and practical alternative to continuous infusion catheters.