Although
total knee arthroplasty (TKA) is a commonly performed procedure,
anesthetic efficacy in
post-surgical pain remains an issue. Exparel (45mM
liposome bupivacaine), a relatively long-acting
local anesthetic, has shown efficacy in blocking peripheral nerve or periarticular infiltration to achieve better post-TKA
analgesia. In the present work, we tested whether a fixed-dose combination of
QX-OH (35mM) and
levobupivacaine (10mM) (
QX-OH/LB) could confer longer-lasting
pain relief and reduce periarticular tissue toxicity compared to
liposome bupivacaine (45mM) after TKA operation. In the sciatic nerve block, the duration of sensory block by
QX-OH/LB was 2-fold higher than by
liposome bupivacaine (median [25th, 75th percentiles], 9.83 [9.33, 10.83] hours versus 4.83 [4.83, 5] hours; P=0.001).
Liposome bupivacaine failed to improve post-surgical travel distance and speed (P=0.373) in rats 6h after TKA surgery (versus saline). Similar results were observed in operated mice treated with
liposome bupivacaine. However,
QX-OH/LB increased locomotor activities markedly both in rats and mice at 6h post-TKA (P<0.001). In addition, there was no difference in the inflammatory recruitment and articular structural damage among murine models-treated with
QX-OH/LB,
liposome bupivacaine and saline. In conclusion, we show that
QX-OH/LB is a safe and long-lasting
anesthetic than
liposome bupivacaine in the post-TKA
pain management in murine models.