Among patients undergoing shoulder arthroplasty, liposomal bupivacaine was shown to provide better pain relief at 19 to 21 weeks post-surgery with fewer complications compared with continuous interscalene nerve block, according to research published in the Journal of Shoulder & Elbow Surgery.
In this prospective clinical trial, 70 patients undergoing shoulder arthroplasty were randomly assigned to receive continuous interscalene nerve block (n=36) or liposomal bupivacaine (n=34) with a single bolus interscalene block.
The primary outcomes of pain assessment and narcotic use within the first 24 hours were not significantly different between the 2 groups (P >.05 for all assessed time intervals between 2 and 24 hours).
At the final follow-up (19 weeks for liposomal bupivacaine and 21 weeks for continuous interscalene nerve block), mean pain scores were improved in the liposomal bupivacaine vs continuous interscalene group, as indicated by the Penn Shoulder Score (mean 56.3 vs 72.3; P =.03) and the American Shoulder and Elbow Surgeons Shoulder Score (59.7 vs 74.5; P =.02).
Fewer complications were reported in the liposomal bupivacaine group compared with the continuous interscalene nerve block group. Most complications in patients receiving interscalene nerve block were related to the catheter. In addition to fewer complications, the use of liposomal bupivacaine was associated with cost savings, noted the investigators.
The researchers concluded that the “use of [liposomal bupivacaine] in conjunction with a single bolus interscalene nerve block [in shoulder arthroplasty patients] was equivalent to the ‘gold standard’ of [continuous interscalene nerve block] in terms of postoperative pain and opioid use…. Postoperative pain control is intimately linked with patient satisfaction and outcomes; having alternatives to continuous nerve block that require less equipment and time and have fewer complications could help improve the recovery experience for these patients.”
Sabesan VJ, Shahriar R, Petersen-Fitts GR, et al. A prospective randomized controlled trial to identify the optimal postoperative pain management in shoulder arthroplasty: liposomal bupivacaine versus continuous interscalene catheter. J Shoulder Elbow Surg. 2017;26:1810-1817.