Liposomal Bupivacaine Versus Standard Analgesia in TJA

Liposomal bupivacaine (Exparel®) is a local anesthetic made up of liposomal encapsulated
bupivacaine. It is designed to be injected at the time of surgery into the local soft
tissues. Because of its unique liposomal delivery system, Liposomal bupivacaine (Exparel®)
has been shown to provide up to 96 hours of pain relief following surgeries. This makes it
an attractive option in total joint arthroplasty patients. Combined with the proven efficacy
of regional anesthesia, intraoperative liposomal bupivacaine (Exparel®) may provide extended
pain relief following total joint arthroplasty. This has the potential to avoid the need for
opioid medications. With better pain control, medication side effects can be avoided and
patient's length of stay in the hospital can be shortened.

Inclusion Criteria:

1. Clinical diagnosis of osteoarthritis

2. Elected to undergo primary TKA, THA, or TSA

Exclusion Criteria:

1. Age < 18 years

2. Pregnant or breastfeeding

3. Non-English speaking

4. Unable to give informed consent

5. Previous open hip, knee or shoulder surgery

6. Pre-determined patients discharging to ECF

7. Patients with allergies to bupivacaine

8. Patients currently taking opioid pain medication

9. Patients with contraindication to nerve blocks

10. Patients undergoing simultaneous bilateral joint replacement, as this would require
>1 dose of liposomal bupivacaine (Exparel®) per patient for each surgical site

11. Patients with severe hepatic disease

12. Patients with chronic heart disease as defined as a decreased ejection fraction