Liposomal Bupivacaine Versus Femoral Nerve Block for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial

Study Design: A randomized single blinded standard of care controlled clinical trial comparing pain management interventions. All patients over age sixteen and scheduled for primary or revision anterior cruciate ligament reconstruction (ACL) a single fellowship trained sports surgeons will be eligible for inclusion. Patients will be excluded if their medical history presents known allergies or intolerance to dexamethasone, opioid or bupivacaine, substantial alcohol or drug abuse, and pregnancy. Secondary exclusion criterion is an intact ACL.

Liposomal Bupivacaine has a refrigerated shelf life of one month in our facility. Patients will be sequentially recruited into the randomization process. Liposomal Bupivacaine will be held by the Henry Ford hospital pharmacy up to one month prior to planned anterior cruciate ligament reconstruction in anticipation of surgery on eligible patients. The sterile solutions will be delivered to and kept by the inpatient clinical pharmacy until the date of surgery and delivered to the operating room at the beginning of a surgical case. The current dose of Liposomal Bupivacaine has been chosen based on previously published data of local infiltrative analgesia with Liposomal Bupivacaine and one published study on Liposomal Bupivacaine efficacy.

The week prior to surgery, patients will be randomized to receive Local infiltration anesthesia (LIA) with Liposomal Bupivacaine, or Femoral nerve block (FNB) using a computer generated sequence. The results of randomization will be securely delivered to the anesthesiologist and the surgeon the week prior. The anesthesiologist will view the assigned group to determine if a preoperative FNB will be given. Depending on the randomization group either an Liposomal Bupivacaine solution will be delivered to the operating room for local infiltration or the anesthesiologist will perform a preoperative FNB.

Patients in the Liposomal Bupivacaine group will receive LIA with 10cc(133mg) of Liposomal Bupivacaine solution dissolved in 20cc of sterile saline after harvest of the hamstring graft or patella tendon graft. The solution will be applied to the wound bed, graft site, and periosteum. The solution will be left unperturbed for five minutes. Thereafter the solution will be suctioned from the wound and the knee joint. Incisions will be closed in typical fashion and the wound dressed.The tourniquet will be deflated.

Patient in the FNB will receive postoperative ultrasound guided FNB. Experienced anesthesiologists will apply all FNBs in this study.