Liposomal bupivacaine nerve block provides better pain control post-total shoulder arthroplasty than continuous indwelling catheter.
Opioid consumption
Pain management
Post-surgical treatment
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
16
09
2021
accepted:
05
02
2022
pubmed:
3
3
2022
medline:
24
3
2023
entrez:
2
3
2022
Statut:
ppublish
Résumé
Pain control is essential to successful total shoulder arthroplasty (TSA). This non-blinded, randomized clinical trial compared shoulder pain, narcotic use, interscalene (IS) block application time, and costs in 76 subjects who were randomly assigned to receive either a single injection IS nerve block of 10 cc (133 mg) liposomal bupivacaine mixed with 10 cc of 0.5% bupivacaine (Group 1), or 20 cc of 0.5% ropivacaine direct injection combined with an indwelling IS nerve block catheter delivering 0.2% ropivacaine at a continual 4 cc/h infusion for the initial 3 post-operative days (Group 2). Surgical time, local anesthesia duration, hospital stay length, morphine milligram equivalents (MME) consumed, worst shoulder pain at 24, 48 and 72 h, and complications were recorded. Patient reported function, pain and activity level surveys were completed before, and 6-week post-TSA (P < 0.05). Group 1 had less pain 24-h (0.72 ± 0.8 vs. 3.4 ± 2.9, p < 0.0001) and 48-h (2.5 ± 2.2 vs. 4.8 ± 2.6, p = 0.005) post-TSA. At 24-h post-TSA, MME consumption was similar (Group 1 = 4.5 ± 6.4 vs. Group 2 = 3.7 ± 3.8, p = 0.54), but was lower for Group 1 at 48 h (0.0 ± 0.0 vs. 0.64 ± 0.99, p = 0.001). Group 2 had longer IS block application time (10.00 ± 4.6 min vs. 4.84 ± 2.7 min, p < 0.0001). Only group 2 had a strong relationship between MME consumption over the first 24-h post-TSA and pain 24-h post-TSA (r = 0.76, p < 0.0001), a moderate relationship with pain 48-h post-TSA (r = 0.59, P = 0.001), and a weak relationship with pain 72-h post-TSA (r = 0.44, P = 0.02). Significant relationships for these variables were not observed for Group 1 (r ≤ 0.30, p ≥ 0.23). Group 1 IS block costs were less/patient than Group 2 ($190.17 vs. $357.12 USD). A single shot, liposomal bupivacaine interscalene nerve block provided better post-TSA pain control with less narcotic consumption, less time for administration and less healthcare system cost compared to interscalene nerve block using a continuous indwelling catheter. Level I, Prospective, Randomized.
Sections du résumé
BACKGROUND
BACKGROUND
Pain control is essential to successful total shoulder arthroplasty (TSA).
MATERIALS AND METHODS
METHODS
This non-blinded, randomized clinical trial compared shoulder pain, narcotic use, interscalene (IS) block application time, and costs in 76 subjects who were randomly assigned to receive either a single injection IS nerve block of 10 cc (133 mg) liposomal bupivacaine mixed with 10 cc of 0.5% bupivacaine (Group 1), or 20 cc of 0.5% ropivacaine direct injection combined with an indwelling IS nerve block catheter delivering 0.2% ropivacaine at a continual 4 cc/h infusion for the initial 3 post-operative days (Group 2). Surgical time, local anesthesia duration, hospital stay length, morphine milligram equivalents (MME) consumed, worst shoulder pain at 24, 48 and 72 h, and complications were recorded. Patient reported function, pain and activity level surveys were completed before, and 6-week post-TSA (P < 0.05).
RESULTS
RESULTS
Group 1 had less pain 24-h (0.72 ± 0.8 vs. 3.4 ± 2.9, p < 0.0001) and 48-h (2.5 ± 2.2 vs. 4.8 ± 2.6, p = 0.005) post-TSA. At 24-h post-TSA, MME consumption was similar (Group 1 = 4.5 ± 6.4 vs. Group 2 = 3.7 ± 3.8, p = 0.54), but was lower for Group 1 at 48 h (0.0 ± 0.0 vs. 0.64 ± 0.99, p = 0.001). Group 2 had longer IS block application time (10.00 ± 4.6 min vs. 4.84 ± 2.7 min, p < 0.0001). Only group 2 had a strong relationship between MME consumption over the first 24-h post-TSA and pain 24-h post-TSA (r = 0.76, p < 0.0001), a moderate relationship with pain 48-h post-TSA (r = 0.59, P = 0.001), and a weak relationship with pain 72-h post-TSA (r = 0.44, P = 0.02). Significant relationships for these variables were not observed for Group 1 (r ≤ 0.30, p ≥ 0.23). Group 1 IS block costs were less/patient than Group 2 ($190.17 vs. $357.12 USD).
CONCLUSION
CONCLUSIONS
A single shot, liposomal bupivacaine interscalene nerve block provided better post-TSA pain control with less narcotic consumption, less time for administration and less healthcare system cost compared to interscalene nerve block using a continuous indwelling catheter.
LEVEL OF EVIDENCE
METHODS
Level I, Prospective, Randomized.
Identifiants
pubmed: 35235030
doi: 10.1007/s00402-022-04386-5
pii: 10.1007/s00402-022-04386-5
doi:
Substances chimiques
Ropivacaine
7IO5LYA57N
Anesthetics, Local
0
MME
78185-58-7
Bupivacaine
Y8335394RO
Narcotics
0
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1895-1902Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Chahar P, Cummings KC 3rd (2012) Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res 5:257–264. https://doi.org/10.2147/JPR.S27894
doi: 10.2147/JPR.S27894
pubmed: 23049275
pmcid: 3442744
Xiao M, Cohen SA, Cheung EV, Freehill MT, Abrams GD (2021) Pain management in shoulder arthroplasty: A systematic review and network meta-analysis of randomized controlled trials. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2021.06.008
doi: 10.1016/j.jse.2021.06.008
pubmed: 34774777
Bishop JY, Sprague M, Gelber J et al (2005) Interscalene regional anesthesia for shoulder surgery. J Bone Joint Surg Am 87(5):974–979. https://doi.org/10.2106/JBJS.D.02003
doi: 10.2106/JBJS.D.02003
pubmed: 15866958
YaDeau JT, Dines DM, Liu SS et al (2019) What pain levels do TSA patients experience when given a long-acting nerve block and multimodal analgesia? Clin Orthop Relat Res 477(3):622–632. https://doi.org/10.1097/CORR.0000000000000597
doi: 10.1097/CORR.0000000000000597
pubmed: 30762694
pmcid: 6382177
Kim N, Matzon JL, Abboudi J et al (2016) A prospective evaluation of opioid utilization after upper-extremity surgical procedures: Identifying consumption patterns and determining prescribing guidelines. J Bone Joint Surg Am 98(20):e89. https://doi.org/10.2106/JBJS.15.00614
doi: 10.2106/JBJS.15.00614
pubmed: 27869630
Bjørnholdt KT, Jensen JM, Bendtsen TF, Søballe K, Nikolajsen L (2015) Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial. Eur J Orthop Surg Traumatol 25(8):1245–1252. https://doi.org/10.1007/s00590-015-1678-2
doi: 10.1007/s00590-015-1678-2
pubmed: 26276164
Verdecchia NM, Rodosky MW, Kentor M, Orebaugh SL (2021) Liposomal bupivacaine infiltration in the surgical site for analgesia after rotator cuff repair: A randomized, double-blinded, placebo-controlled trial. J Shoulder Elbow Surg 30(5):986–993. https://doi.org/10.1016/j.jse.2020.10.035
doi: 10.1016/j.jse.2020.10.035
pubmed: 33290853
Panchamia JK, Amundson AW, Jacob AK et al (2019) A 3-arm randomized clinical trial comparing interscalene blockade techniques with local infiltration analgesia for total shoulder arthroplasty. J Shoulder Elbow Surg 28(10):e325–e338. https://doi.org/10.1016/j.jse.2019.05.013
doi: 10.1016/j.jse.2019.05.013
pubmed: 31353302
Kolade O, Patel K, Ihejirika R et al (2019) Efficacy of liposomal bupivacaine in shoulder surgery: A systematic review and meta-analysis. J Shoulder Elbow Surg 28(9):1824–1834. https://doi.org/10.1016/j.jse.2019.04.054
doi: 10.1016/j.jse.2019.04.054
pubmed: 31324503
Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G (2017) Randomized controlled trial of interscalene block compared with injectable liposomal bupivacaine in shoulder arthroplasty. J Bone Joint Surg Am 99(7):550–556. https://doi.org/10.2106/JBJS.16.00296
doi: 10.2106/JBJS.16.00296
pubmed: 28375887
Banghu M, Mutter T, Dubberley J, MacDonald P, Dufault B, Amadeo R (2017) Single-injection interscalene bupivacaine and dexamethasone for same-day discharge total shoulder arthroplasty: A case series. Can J Anaesth 64(4):435–437. https://doi.org/10.1007/s12630-016-0788-6
doi: 10.1007/s12630-016-0788-6
pubmed: 27921215
Sun H, Li S, Wang K et al (2018) Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: A systematic review and meta-analysis. J Pain Res 11:1889–1900. https://doi.org/10.2147/JPR.S177716
doi: 10.2147/JPR.S177716
pubmed: 30271195
pmcid: 6151095
YaDeau JT, Gordon MA, Goytizolo EA et al (2016) Buprenorphine, clonidine, dexamethasone, and ropivacaine for interscalene nerve blockade: A prospective, randomized, blinded, ropivacaine dose-response study. Pain Med 17(5):940–960. https://doi.org/10.1093/pm/pnv010
doi: 10.1093/pm/pnv010
pubmed: 26814246
Wang K, Zhang H-X (2017) Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis. Int J Surg 46:61–70. https://doi.org/10.1016/j.ijsu.2017.08.569
doi: 10.1016/j.ijsu.2017.08.569
pubmed: 28843463
Tetzlaff JE, Yoon HJ, Brems J (1994) Interscalene brachial plexus block for shoulder surgery. Reg Anesth 19(5):339–343
pubmed: 7848934
Routman HD, Israel LR, Moor MA, Boltuch AD (2017) Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty. J Shoulder Elbow Surg 26(4):641–647. https://doi.org/10.1016/j.jse.2016.09.033
doi: 10.1016/j.jse.2016.09.033
pubmed: 27856266
Auyong DB, Yuan SC, Choi DS, Pahang JA, Slee AE, Hanson NA (2017) A double-blind randomized comparison of continuous interscalene, supraclavicular, and suprascapular blocks for total shoulder arthroplasty. Reg Anesth Pain Med 42(3):302–309. https://doi.org/10.1097/AAP.0000000000000578
doi: 10.1097/AAP.0000000000000578
pubmed: 28272290
Chalmers PN, Salazar D, Fingerman ME, Keener JD, Chamberlain A (2017) Continuous interscalene brachial plexus blockade is associated with reduced length of stay after shoulder arthroplasty. Orthop Traumatol Surg Res 103(6):847–852. https://doi.org/10.1016/j.otsr.2017.06.007
doi: 10.1016/j.otsr.2017.06.007
pubmed: 28688963
Bojaxhi E, Lumermann LA, Mazer LS, Howe BL, Ortiguera CJ, Clendenen SR (2019) Interscalene brachial plexus catheter versus single-shot interscalene block with periarticular local infiltration analgesia for shoulder arthroplasty. Minerva Anestesiol 85(8):840–845. https://doi.org/10.23736/S0375-9393.19.13387-1
doi: 10.23736/S0375-9393.19.13387-1
pubmed: 31106552
McNaught A, McHardy P, Awad IT (2010) Posterior interscalene block: an ultrasound-guided case series and overview of history, anatomy and techniques. Pain Res Manag 15(4):219–223. https://doi.org/10.1155/2010/758174
doi: 10.1155/2010/758174
pubmed: 20808966
pmcid: 2935721
Gabriel RA, Nagrebetsky A, Kaye AD, Dutton RP, Urman RD (2016) The patterns of utilization of interscalene nerve blocks for total shoulder arthroplasty. Anesth Analg 123(3):758–761. https://doi.org/10.1213/ANE.0000000000001472
doi: 10.1213/ANE.0000000000001472
pubmed: 27537763
Updegrove GF, Stauch CM, Ponnuru P, Kunselman AR, Armstrong AD (2020) Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES Int 4(2):357–361. https://doi.org/10.1016/j.jseint.2019.12.007
doi: 10.1016/j.jseint.2019.12.007
pubmed: 32490426
pmcid: 7256779
Thompson M, Simonds R, Clinger B et al (2017) Continuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay. J Shoulder Elbow Surg 26(4):656–661. https://doi.org/10.1016/j.jse.2016.09.026
doi: 10.1016/j.jse.2016.09.026
pubmed: 28277258
Choi S, Rodseth R, McCartney CJ (2014) Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br J Anaesth 112(3):427–439. https://doi.org/10.1093/bja/aet417
doi: 10.1093/bja/aet417
pubmed: 24413428
Wells N, Pasero C, McCaffery M (2008) Improving the quality of care through pain assessment and management. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US) Chapter 17
Vorobeichik L, Brull R, Bowry R, Laffey JG, Abdallah FW (2018) Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and risk-effects profiles. Br J Anaesth 120(4):679–692. https://doi.org/10.1016/j.bja.2017.11.104
doi: 10.1016/j.bja.2017.11.104
pubmed: 29576109
Codding JL, Getz CL (2018) Pain management strategies in shoulder arthroplasty. Orthop Clin North Am 49:81–91. https://doi.org/10.1016/j.ocl.2017.08.010
doi: 10.1016/j.ocl.2017.08.010
pubmed: 29145989
Budge M, Orvets N, Shields E (2020) Single-shot liposomal bupivacaine interscalene nerve block provides equivalent pain relief compared to continuous catheter interscalene nerve block in total shoulder arthroplasty. JSESArthro 30(4):285–290. https://doi.org/10.1053/j.sart.2020.09.003
doi: 10.1053/j.sart.2020.09.003
Ilfeld BM, Viscusi ER, Hadzic A et al (2015) Safety and side effect profile of liposome bupivacaine (exparel) in peripheral nerve blocks. Reg Anesth Pain Med 40(5):572–582. https://doi.org/10.1097/AAP.0000000000000283
doi: 10.1097/AAP.0000000000000283
pubmed: 26204387
Sicard J, Klouche S, Conso C et al (2019) Local infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: A prospective, randomized, comparative noninferiority study involving 99 patients. J Shoulder Elbow Surg 28(2):212–219. https://doi.org/10.1016/j.jse.2018.09.026
doi: 10.1016/j.jse.2018.09.026
pubmed: 30545786
Hattrup SJ, Chung AS, Rosenfeld DM et al (2021) Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: A double-blinded prospective randomized control trial. J Shoulder Elbow Surg 30(3):587–598. https://doi.org/10.1016/j.jse.2020.09.017
doi: 10.1016/j.jse.2020.09.017
pubmed: 33045330
Abildgaard JT, Lonergan KT, Tolan SJ et al (2017) Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: A prospective randomized controlled trial. J Shoulder Elbow Surg 26(7):1175–1181. https://doi.org/10.1016/j.jse.2017.03.012
doi: 10.1016/j.jse.2017.03.012
pubmed: 28479257
Yan Z, Chen Z, Ma C (2017) Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis. Medicine (Baltimore) 96(27):e7226. https://doi.org/10.1097/MD.000000000000722634
doi: 10.1097/MD.000000000000722634
pubmed: 28682872
Weir TB, Simpson N, Aneizi A et al (2020) Single-shot liposomal bupivacaine interscalene block versus continuous interscalene catheter in total shoulder arthroplasty: Opioid administration, pain scores, and complications. J Orthop 22:261–267. https://doi.org/10.1016/j.jor.2020.05.006
doi: 10.1016/j.jor.2020.05.006
pubmed: 32435107
pmcid: 7231813
Cao X, Pan F (2017) Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty: A meta-analysis of randomized control trails. Medicine (Baltimore) 96(39):e8079. https://doi.org/10.1097/MD.0000000000008079
doi: 10.1097/MD.0000000000008079
pubmed: 28953626
Angerame MR, Ruder JA, Odum SM, Hamid N (2017) Pain and opioid use after total shoulder arthroplasty with injectable liposomal bupivacaine versus interscalene block. Orthop 40(5):e806–e811. https://doi.org/10.3928/01477447-20170608-01
doi: 10.3928/01477447-20170608-01
Sethi PM, Brameier DT, Mandava NK, Miller SR (2019) Liposomal bupivacaine reduces opiate consumption after rotator cuff repair in a randomized controlled trial. J Shoulder Elbow Surg 28(5):819–827. https://doi.org/10.1016/j.jse.2019.01.008
doi: 10.1016/j.jse.2019.01.008
pubmed: 30928396
Patel MA, Gadsden JC, Nedeljkovic SS et al (2020) Brachial plexus block with liposomal bupivacaine for shoulder surgery improves analgesia and reduces opioid consumption: Results from a multicenter, randomized, double-blind, controlled trial. Pain Med 21(2):387–400. https://doi.org/10.1093/pm/pnz103
doi: 10.1093/pm/pnz103
pubmed: 31150095
Namdari S, Nicholson T, Abboud J, Lazarus M, Steinberg D, Williams G (2018) Interscalene block with and without intraoperative local infiltration with liposomal bupivacaine in shoulder arthroplasty: A randomized controlled trial. J Bone Joint Surg Am 100(16):1373–1378. https://doi.org/10.2106/JBJS.17.01416
doi: 10.2106/JBJS.17.01416
pubmed: 30106818
Kocher M, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ (2005) Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg 87(9):2006–2011. https://doi.org/10.2106/JBJS.C.01624
doi: 10.2106/JBJS.C.01624
pubmed: 16140816
Furtado R, MacDermid J (2019) Clinimetrics: Single assessment numeric evaluation. Bone Joint Institute 65(2):111. https://doi.org/10.1016/j.jphys.2019.02.001
doi: 10.1016/j.jphys.2019.02.001
Thigpen CA, Shanley E, Momaya AM, Kissenberth MJ, Tolan SJ, Tokish JM, Hawkins RJ (2018) Validity and responsiveness of the single alpha-numeric evaluation for shoulder patients. Am J Sports Med 46(14):3480–3485. https://doi.org/10.1177/0363546518807924
doi: 10.1177/0363546518807924
pubmed: 30419173
Bijur PE, Silver W, Gallagher EJ (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8:1153–1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
doi: 10.1111/j.1553-2712.2001.tb01132.x
pubmed: 11733293
Mukaka MM (2012) Statistics Corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24(3):69–71
pubmed: 23638278
pmcid: 3576830
Harjula JNE, Paloneva J, Haapakoski J, Kukkonen J, Äärimaa V (2018) Increasing incidence of primary shoulder arthroplasty in Finland - a nationwide registry study. BMC Musculoskelet Disord 19(1):245. https://doi.org/10.1186/s12891-018-2150-3
doi: 10.1186/s12891-018-2150-3
pubmed: 30031390
pmcid: 6054850
Kim SH, Wise BL, Zhang Y, Szabo RM (2011) Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 93(24):2249–2254. https://doi.org/10.2106/JBJS.J.01994
doi: 10.2106/JBJS.J.01994
pubmed: 22258770
Best MJ, Aziz KT, Wilckens JH, McFarland EG, Srikumaran U (2021) Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg 30(5):1159–1166. https://doi.org/10.1016/j.jse.2020.08.010
doi: 10.1016/j.jse.2020.08.010
pubmed: 32858194
Charles MD, Cvetanovich G, Sumner-Parilla S, Nicholson GP, Verma N, Romeo AA (2019) Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. J Shoulder Elbow Surg 28(6S):S118–S123. https://doi.org/10.1016/j.jse.2019.04.006
doi: 10.1016/j.jse.2019.04.006
pubmed: 31133407
Sabesan VJ, Shahriar R, Petersen-Fitts GR, Whaley JD, Bou-Akl T, Sweet M, Milia M (2017) A prospective randomized controlled trial to identify the optimal postoperative pain mangement in shoulder arthroplasty: Liposomal bupivacaine versus continuous interscalene catheter. J Shoulder Elbow Surg 26:1810–1817. https://doi.org/10.1016/j.jse.2017.06.044
doi: 10.1016/j.jse.2017.06.044
pubmed: 28844420
Malik O, Kaye AD, Kaye A, Belani K, Urman RD (2017) Emerging roles of liposomal bupivacaine in anesthesia practice. J Anaesthesiol Clin Pharmacol 33:151–156. https://doi.org/10.4103/joacp.JOACP_375_15
doi: 10.4103/joacp.JOACP_375_15
pubmed: 28781438
pmcid: 5520585