Liposomal bupivacaine nerve block provides better pain control post-total shoulder arthroplasty than continuous indwelling catheter

Krupp, Ryan; Smith, Austin; Nyland, John; Mojesky, Colton; Perkins, D.; Carreon, Leah Y.

doi:10.1007/s00402-022-04386-5

Cited by 10 publications

(9 citation statements)

References 49 publications

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“…The remaining 10 studies demonstrated comparable postoperative LOS between the two treatments and were determined to have a moderate level of scientific certainty. [26,27,[29][30][31][32][33][34][35][36] Two studies did not report LOS (Table 1) [25,37].…”

Section: Resultsmentioning

confidence: 99%

“…This remained true across multiple methods of administration, and only veered in cases where physician's fees or indwelling catheters were added. [26,27] With such limited findings on the efficacy of LB's ability to reduce hospital costs or opioid dependency for patients when compared with ROPI, it brings into question whether hospitals, physicians, insurance companies, and most importantly patients should be spending such an increased amount on a drug without proven additional benefit. Hamilton et al conducted a health economics analysis on their RCT comparing LB to BUPI evaluating post-trial cost utility.…”

Section: Discussionmentioning

confidence: 99%

“…Four of these studies did not blind the participants. [25,27,28,30] One study included chronic opioid users only in the cohort that received ROPI but none in LB group, thus introducing bias. [28] Krupp et al [27] and Okoroha et al [26] also used different infiltration sites and mechanisms of administration in their LB vs. ROPI comparison trials, introducing indirectness between study group outcomes, as the treatments were not equivalent.…”

Section: Grade Scoresmentioning

confidence: 99%

“…[25,27,28,30] One study included chronic opioid users only in the cohort that received ROPI but none in LB group, thus introducing bias. [28] Krupp et al [27] and Okoroha et al [26] also used different infiltration sites and mechanisms of administration in their LB vs. ROPI comparison trials, introducing indirectness between study group outcomes, as the treatments were not equivalent. Ali et al was the only study to report the use of LB increased OME requirements, therefore demonstrating inconsistency as it was the only study to report this outcome.…”

Section: Grade Scoresmentioning

confidence: 99%

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Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

2022

J Surg

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Introduction: Liposomal bupivacaine (LB) is a long-acting analgesic that, due to its liposomal formulation, purportedly extends its analgesic effect up to 72 hours. However, the clinical efficacy of LB appears mixed. This systematic review seeks to evaluate the effectiveness of liposomal bupivacaine in improving postoperative outcomes compared to ropivacaine (ROPI), another commonly used long-acting analgesic. Materials and Methods:Prospective and randomized controlled trials (RCTs) evaluating the efficacy of LB compared to ROPI were selected for review. Primary outcomes included hospital length of stay (LOS) and postoperative opioid consumption measured in oral morphine equivalents (OME). Secondary outcomes included analgesic cost.Results: 14 studies met the review criteria. We found that LB and ROPI are equivalent in managing postoperative pain. 8 of the 14 trials reported equal efficacy between LB and ROPI as determined by OME post-procedure and 10 of the 14 trials reported similar LOS after surgery. These findings remained consistent across multiple surgical procedures and multiple drug administrative modalities. Conclusion:Our systematic review found that LB was not superior to ROPI in reducing postoperative OME use and hospital LOS. The only consistent finding was the significantly increased cost of LB compared to that of ROPI. Therefore, the use of LB over ROPI cannot be justified.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Grade Scoresmentioning

confidence: 99%

Section: Grade Scoresmentioning

confidence: 99%

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Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

2022

J Surg

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“…Systematic review found that liposomal bupivacaine was comparable to nonliposomal local anesthetics for TSA [17 ▪▪ ]. Some unblinded data indicate that liposomal bupivacaine reduced pain scores after TSA, compared to interscalene catheters [18]. A larger blinded RCT found no clinically relevant advantage of liposomal bupivacaine vs. plain bupivacaine when used included in the ISB for TSA [19 ▪▪ ].…”

Section: Analgesic Pathway Componentsmentioning

confidence: 99%

Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTotal shoulder arthroplasty (TSA) is growing in popularity and is increasingly done on an ambulatory basis. This review examines recent developments in anesthesia and analgesia for ambulatory shoulder surgery. Pathway components are discussed and a sample pathway is described. Recent FindingsAdoption of pathways for shoulder surgery improves patient experience by reducing pain, opioid use, and side effects while improving patient satisfaction. Long-acting nerve blockade using adjuvants like dexamethasone provide long-lasting analgesia without rebound pain. Peripheral nerve blockade provides better analgesia than peri-articular injection of local anesthetic. There are multiple approaches to nerve blockade for shoulder surgery to consider, including interscalene, superior trunk, supraclavicular, and anterior suprascapular nerve blocks. Multimodal analgesia should include acetaminophen and nonsteroidal anti-inflammatory drugs, but routine gabapentinoids should not be used.

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Interscalene block vs. periarticular liposomal bupivacaine for pain control following reverse shoulder arthroplasty: a randomized trial

Schumaier

Kloby

Hasselfeld

et al. 2023

Journal of Shoulder and Elbow Surgery

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Liposomal bupivacaine nerve block provides better pain control post-total shoulder arthroplasty than continuous indwelling catheter

Cited by 10 publications

References 49 publications

Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

Clinical care pathways for ambulatory total shoulder arthroplasty

Interscalene block vs. periarticular liposomal bupivacaine for pain control following reverse shoulder arthroplasty: a randomized trial

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