Surgical site injection of liposomal bupivacaine reduces 90-day incidence of major complications after hip fracture: a nonrandomized trial.

BACKGROUND

Early recovery of mobilization after geriatric hip fracture is associated with lower complication incidence and mortality. Whether surgical site injection of liposomal bupivacaine (LB) can reduce incidence of major complications after hip fracture in elderly population remains unclear.

MATERIALS AND

METHODS

In this nonrandomized trial, we enrolled participants of an observational cohort who received surgical treatment of a hip fracture and were aged 65 years or older from October 2023 to June 2024. We used the participants of this observational cohort from October 2020 to September 2023 as historical control. The primary outcome was a pre-defined composite of major complications including mortality, stroke, myocardial infarction, sepsis, major bleeding, venous thromboembolism, pressure ulcer, and pneumonia within 90 postoperative days. Secondary outcomes were all-cause mortality, weight-bearing within 24 hours after surgery, and delirium within 7 postoperative days.

RESULTS

In this study, 134 patients received surgical site injection of LB to attenuate postoperative pain intensity and completed the 90-day follow-up. Patients in the LB group had a reduced incidence of major complications within 90 days [19 (14.2%) patients vs. 167 (24.6%) patients] compared with patients in the control group, with an adjusted hazard ratio (HR) of 0.55 [95% confidence interval (CI) 0.34-0.89, P = .014]. For secondary endpoints, death occurred in 8 (6.0%) patients of the LB group and 58 (8.5%) of the control group, with an HR of 0.74 (0.35-1.56, P = 0.432). The incidence of delirium was similar between the two group [LB group 6 patients (4.5%) vs. control group 49 (7.2%) patients, P = 0.254]. Seventy-three patients in the LB group (54.5%) achieved weight-bearing within 24, while 225 patients in the control group (33.1%) achieved this goal, with an odds ratio of 2.40 (1.64-3.51, P < 0.001).

CONCLUSIONS

With surgical site injection of LB, patient might have reduced incidence of major complications. The benefits of LB regarding all-cause mortality and delirium were not observed in this study, possibly due to insufficient power. Future randomized clinical trials with larger sample sizes were warranted by the current study.