title: Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: a prospective randomized trial.
abstract: OBJECTIVE
  Our hypothesis was that in patients undergoing shoulder arthroplasty, a prospective randomized trial would find no significant differences in average daily pain scores of those treated with interscalene nerve block (INB) vs. local liposomal bupivacaine (LB).
  
  
  METHODS
  Sixty patients undergoing primary shoulder arthroplasty were assessed for eligibility. Study arms included either intraoperative local infiltration of LB (20 mL bupivacaine/20 mL saline) or preoperative INB, with a primary outcome of postoperative average daily visual analog scale scores for 4 days. Secondary outcomes assessed included opioid consumption, length of stay, and complications. Randomization was by a computerized algorithm. Only the observer was blinded to the intervention.
  
  
  RESULTS
  Three patients were excluded, all before randomization. A total of 57 patients were analyzed. Outcomes showed a significant increase in pain in the LB group between 0 and 8 hours postoperatively (mean [standard deviation] 5.3 [2.2] vs. 2.5 [3.0]; P = .001). A significant increase in intravenous morphine equivalents was found in the INB group at 13 to 16 hours (mean [standard deviation] 1.2 [0.9] vs. 0.6 [0.7]; P = .01). No significant differences were found in any variable after postoperative day 0 between the 2 groups.
  
  
  CONCLUSIONS
  An increase in early postoperative pain on the day of surgery was found with LB, whereas the INB group required more narcotics at the end of the day. After the day of surgery, there were no significant differences found in any variables. These findings suggest that LB provides similar overall pain relief as INB, with no increase in complications or length of stay and a decrease in narcotic requirements on the day of surgery.
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA. Electronic address: KROKOROHA@Gmail.com.
authors.forename: Kelechi R
authors.initials: KR
authors.lastname: Okoroha
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Lynch
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Keller
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: John
authors.initials: J
authors.lastname: Korona
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Amato
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Rill
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Kolowich
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Muh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000072228:Arthroplasty, Replacement, Shoulder; D001917:Brachial Plexus; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D012785:Shoulder Joint / Q000294:innervation / Q000601:surgery; D064232:Visual Analog Scale
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: Total shoulder arthroplasty; interscalene nerve block; liposomal bupivacaine; local infiltration; pain control; reverse total shoulder arthroplasty