Risk factors for complications and return to the emergency department after interscalene block using liposomal bupivacaine for shoulder surgery

Malige, Ajith; Yeazell, Shawn; Ng-Pellegrino, Anna; Carolan, G.

doi:10.1016/j.jse.2020.03.012

Cited by 10 publications

(10 citation statements)

References 27 publications

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“… 30 However, in a recent retrospective review of 352 patients who received ISB-LB after undergoing shoulder surgery, postoperative complications related to prolonged clinical effects of the intervention were noted in 16.5% of patients, with 6% of patients requiring a return to the emergency department and half of these patients requiring readmission for supportive care. 31 Most common symptoms included dyspnea and chest pain (12.5%) and a number of patients reporting swelling, dermatitis, and hematomas at the site of ISB injection (1.7%). It was noted that higher ASA physical status score was the strongest predictor of the occurrence of complications, and this encompassed patients with a history of cardiopulmonary disease and advanced age.…”

Section: Discussionmentioning

confidence: 99%

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

Kwater¹,

Hernandez²,

Artime³

et al. 2021

LRA

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kwater¹,

Hernandez²,

Artime³

et al. 2021

LRA

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“…Liposomal bupivacaine use in ISNB is a newer practice. It has demonstrated effectiveness in areas including analgesia and decreased opioid consumption [3,27]. Despite this, risks of liposomal bupivacaine in ISNB are apparent.…”

Section: Liposomal Bupivacainementioning

confidence: 99%

Postoperative pain control for shoulder arthroplasty

Walker,

Kamineni

2024

Clin Shoulder Elb

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Since its inception in 1893, shoulder arthroplasty has become an increasingly common surgical procedure. Between 1998 and 2008, shoulder arthroplasty procedures increased by nearly 28,000 cases per year in the United States alone and is the fastest growing joint replacement surgery among all joint. Despite its advantages, shoulder arthroplasty is often accompanied by significant postoperative pain. Pain control continues to be a major concern in patient management, as it impacts operative costs, postoperative mobility, length of hospital stay, patient satisfaction, and overall surgical outcomes. This review aims to provide an overview of drugs such as opioids and regional anesthetics, as well as methods such as local wound infiltration, nerve block, brachial plexus infiltration, cryotherapy and multimodal approaches employed in postoperative shoulder arthroplasty pain control.

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Section: Post-surgical Ra Complicationsmentioning

confidence: 99%

“…Two common post-surgical RA-related ED presentations include shortness of breath secondary to diaphragmatic paralysis and displaced/malfunctioning continuous RA catheters [67]. Several brachial plexus blocks commonly administered for shoulder surgeries carry a known risk of temporary diaphragmatic paralysis [67][68][69]. Depending on the type of anesthetic used, diaphragmatic paralysis may last upwards of 24 h. Often, patients presenting with this complication are initially mistaken for a pneumothorax, as the clinical presentation of dyspnea with decreased unilateral breath sounds is similar for both pathologies.…”

Section: Post-surgical Ra Complicationsmentioning

confidence: 99%

Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature

Malik

Thom

Haber

et al. 2022

Curr Emerg Hosp Med Rep

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Purpose of Review This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED. Recent Findings The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized. Summary Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.

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Risk factors for complications and return to the emergency department after interscalene block using liposomal bupivacaine for shoulder surgery

Cited by 10 publications

References 27 publications

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

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

Postoperative pain control for shoulder arthroplasty

Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature

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