Effect of Liposomal Bupivacaine for Fascia Iliaca Compartment Block on Early Postoperative Recovery Quality in Elderly Patients Undergoing Total Hip Arthroplasty: A Retrospective Cohort Study

Introduction: This retrospective cohort study aimed to determine whether liposomal bupivacaine used in suprainguinal fascia iliaca compartment block (S-FICB) is superior to 0.33% ropivacaine in improving the quality of early postoperative recovery in elderly patients with hip fractures who underwent total hip arthroplasty (THA). Outcomes included: 15-item Quality of Recovery Scale (QoR-15); Numerical Rating Scale (NRS) for pain; Pittsburgh Sleep Quality Index (PSQI); Harris Hip Score; plus rescue analgesic use and hospital stay. It should be noted that the observed benefits are limited to the early postoperative period. Methods: A retrospective analysis was conducted on 200 elderly patients (aged 65-85 years) with hip fractures who underwent total hip arthroplasty (THA). Patients were divided into two groups based on the local anesthetic they received for S-FICB: the ropivacaine group (RG group, n = 100) or the liposomal bupivacaine group (LBG group, n = 100). QoR-15 and Harris scores were recorded preoperatively and on days 1, 3, 5 postoperatively. NRS and PSQI were recorded preoperatively and on days 1, 2, 3, 5. Rescue analgesic consumption and hospital stay were recorded. Results: On postoperative day 1, QoR-15 was higher in LBG vs RG (113.25±3.825 vs 105.6±3.75, P=0.0004). NRS was lower in LBG within the first 48 postoperative hours (P < 0.05). PSQI was better in LBG on postoperative days 1 and 2 (P < 0.01). Harris score was higher in LBG on postoperative day 1 (P = 0.0007). Rescue analgesic use and postoperative hospital stay were lower in LBG (P < 0.05). Conclusion: Liposomal bupivacaine is superior to ropivacaine in the early postoperative recovery and analgesia of elderly THA patients. However, this advantage is primarily limited to the early postoperative period. Prospective validation is required given the retrospective design.