Pain and Opioid Use After Total Shoulder Arthroplasty With Injectable Liposomal Bupivacaine Versus Interscalene Block

Abstract

Postoperative pain control is a significant concern after total shoulder arthroplasty. Injectable periarticular liposomal bupivacaine, which has been found to decrease opioid use after orthopedic procedures, has been proposed as a viable alternative to regional anesthesia. This study compared the efficacy of liposomal bupivacaine vs interscalene block among patients undergoing total shoulder arthroplasty. A retrospective review was conducted of 79 patients who underwent anatomic total shoulder arthroplasty performed by a single surgeon between January 2013 and April 2015. Patient demographics, in-hospital Numeric Pain Rating Scale (NPRS) score obtained at 12-hour intervals, length of stay, and total in-hospital morphine equivalents in both the bupivacaine (n=25) and block (n=44) groups were recorded. Differences in length of stay, morphine equivalents, and age were assessed with Wilcoxon tests. Sex differences were assessed with the chi-square test. Repeated measures analysis with least square means was used to assess longitudinal changes in NPRS scores. No significant differences were found between groups for sex (P=.89), age (P=.81), American Society of Anesthesiologists classification (P=.50), preoperative opioid use (P=.41), length of stay (P=.32), or morphine equivalents (P=.71). The average NPRS score in the first 12 hours was 3.01 for the bupivacaine group and 4.41 for the interscalene block group (P=.25). By 48 hours postoperatively, average NPRS scores were similar (P=.93) for the 2 groups, 4.90 for the bupivacaine group and 4.19 for the interscalene block group. The findings for this cohort of patients undergoing anatomic total shoulder arthroplasty showed no significant difference for pain scores, postoperative narcotic use, or length of stay with injectable liposomal bupivacaine vs interscalene block. [Orthopedics. 2017; 40(5):e806-e811.].

Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: a systematic review and meta-analysis

“…The characteristics of the included studies are summarized in Table 1 . We identified four RCTs 20 , 25 , 27 , 28 and three retrospective controlled studies 18 , 19 , 26 in our study. The trials compared LB vs INB for pain control after TSA.…”

“…The outcomes of pain score at 12 hours after TSA were reported in five studies. 19 , 20 , 26 – 28 Given the significant heterogeneity among these studies ( I 2 =53%, P =0.07), a random- effects model was used. The pooled results revealed that the two groups had comparable pain scores at 12 hours (SMD =−0.01, 95% CI=−0.33 to 0.31, P =0.96; Figure 2C ).…”

“…The pain scores at POD 1 after TSA were provided in four studies. 19 , 20 , 25 , 28 A fixed-effects model was used because of low heterogeneity ( I 2 =0%, P =0.48). The difference in pain scores at POD 1 between the LB and INB groups was not statistically significant according to our analysis (SMD =0.10, 95% CI=−0.15 to 0.35, P =0.42; Figure 2E ).…”

“…Four studies reported the pain scores at POD 2 after TSA. 19 , 20 , 25 , 28 No significant heterogeneity was found ( I 2 =0%, P =0.85), and hence, a fixed-effects model was used. Similarly, the pooled results showed that the two groups had comparable pain scores at POD 2 (SMD =0.16, 95% CI=−0.10 to 0.42, P =0.24; Figure 2F ).…”

“… 15 , 16 , 18 Additionally, we noticed a new RCT and a new retrospective study were published in 2017. 19 , 20 Therefore, we considered it necessary to conduct a new meta-analysis to perform a relatively more credible and overall assessment of the efficiency and safety of LB-based infiltration and INB for pain management after TSA.…”