In a retrospective cohort study accepted by JOA in April 2014, Bagsby et al (senior author Dr. R. Michael Meneghini) concluded that administration of periarticular Bupivacaine (Exparel) during total knee arthroplasty resulted in inferior pain control as compared to a standard PAI consisting of ropivacaine, morphine, and epinephrine. The Bupivacaine PAI group (n=65) reported increased VAS pain scores after 24 hours of hospitalization (p=0.04) and a lower percentage (16.9%) of patients rating pain as “mild” when compared to the traditional PAI cohort (n=85). This article contradics several studies that have reported using Bupivacaine (Exparel) as part of a multimodal pain management approach in TKA (i.e. Manning et al, JOA Feb 2014) with considerable success.