Interscalene Block for Analgesia in Orthopedic Treatment of Shoulder Trauma: Single-Dose Liposomal Bupivacaine versus Perineural Catheter

Abstract

Background Interscalene brachial plexus block is frequently utilized to provide perioperative analgesia to patients undergoing shoulder surgery to optimize recovery, minimize opioid consumption, and decrease overall hospital length of stay. The use of an indwelling perineural interscalene catheter provides extended analgesia and is efficacious in managing severe postoperative pain following major shoulder surgery. Currently, the only alternative to perineural catheters for extended analgesia with interscalene block involves the perineural infiltration of liposomal bupivacaine. However, there is limited published data regarding the overall analgesic effectiveness of using interscalene liposomal bupivacaine in the setting of shoulder surgery. Methods We performed a retrospective review of 43 patients in the acute trauma setting who underwent major shoulder surgery and received extended analgesia via perioperative interscalene brachial plexus block with either an indwelling continuous catheter or single-dose liposomal bupivacaine to determine if comparable analgesia can be achieved. The primary outcomes of interest were postoperative pain scores and opioid consumption. Due to the ability to titrate and bolus local anesthetic infusions to a desired clinical effect, we hypothesized that opioid consumption and pain scores would be lower when using the continuous catheter technique. Results After statistical analysis, our results demonstrated no significant difference between the two techniques in regards to opioid consumption as well as numeric pain scores during the 48-hour postoperative period, but did note a higher rate of complications with patients who received perineural interscalene continuous catheters. Secondary outcomes showed an increase in time required to complete the regional block procedure with the use of indwelling catheters. Conclusion Interscalene brachial plexus block with liposomal bupivacaine may be a viable alternative to indwelling continuous catheters for providing extended analgesia in patients undergoing major shoulder surgery.

Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair

“…Intraoperative and postoperative analgesia are significant concerns in patients undergoing RCR, as this surgery is associated with significant postoperative pain that affects both short-term patient comfort and longer-term recovery [7]. Regional anesthesia, often in the form of an interscalene nerve block, combined with GA has proven very effective at managing postoperative pain in these patients [6][7][8]15]. It is not known whether the type of GA, when combined with regional anesthesia, influences postoperative pain and intra and postoperative opioid consumption.…”

“…General anesthesia with an endotracheal tube is typically the standard technique used in RCR due to several factors, including patient positioning and facilitating hypotensive anesthesia to minimize intraoperative blood loss [6]. In patients undergoing RCR, the use of peripheral nerve blocks is proven to be a beneficial adjunct to general anesthesia (GA) for both intraoperative and early postoperative pain control; interscalene blocks are one of the most effective peripheral nerve blocks in RCR [6][7][8].…”

Evidence-Based Orthopaedic Post-Operative Opioid Prescribing Recommendations Following Shoulder Surgery

“…However, there was an increased complication rate associated with catheter use. 102 Single interscalene injections with either liposomal bupivacaine or standard bupivacaine combined with additives such as perineural dexamethasone have been recently seen as effective strategies in prolonging pain control timelines up to 72 hours and minimizing diaphragmatic dysfunction. 103-105 However, the actual clinical value of liposomal bupivacaine over standard bupivacaine for interscalene blocks remains undetermined.…”