title: Local injection of liposomal bupivacaine combined with intravenous dexamethasone reduces postoperative pain and hospital stay after shoulder arthroplasty.
abstract: BACKGROUND
  Alternative techniques have been developed to address pain after shoulder arthroplasty and are well documented. We evaluated the effect of adding intraoperative liposomal bupivacaine and intravenous dexamethasone during shoulder arthroplasty.
  
  
  METHODS
  We retrospectively reviewed 2 consecutive cohorts undergoing elective shoulder arthroplasty. The 24 patients in cohort 1 and the 31 patients in cohort 2 received perioperative multimodal management with preoperative and postoperative intravenous and oral narcotics, gabapentin, nonsteroidal anti-inflammatory drugs, acetaminophen, and single-injection interscalene block. Cohort 2 also received 8 to 10 mg of intravenous dexamethasone intraoperatively after the skin incision and liposomal bupivacaine injected at surgery. Patients who did and did not use preoperative narcotics were analyzed together and separately. We evaluated hospitalization length of stay, narcotic use, and visual analog scale pain before and after the change in the perioperative protocol.
  
  
  RESULTS
  Cohort 1 was hospitalized longer (2 vs. 1 day; P < .001), required more narcotics on postoperative day 1 (21.0 vs. 10.0 mg; P < .001) and days 0 and 1 cumulatively (30.5 vs. 17.5 mg; P = .001), and had more pain on postoperative days 0 (6.5 vs. 3.5; P < .001) and 1 (7.5 vs. 3.5; P < .001) than cohort 2. In patients using preoperative narcotics, cohort 2 had less pain on postoperative day 1 (3.5 vs. 7.0; P = .006), less cumulative narcotic use (20 vs. 58.5 mg; P = .03), and shorter hospitalization (1 vs. 2 days; P = .052) than cohort 1.
  
  
  CONCLUSIONS
  These changes to the perioperative shoulder arthroplasty protocol decreased hospitalization length of stay, narcotic requirement, and pain.
authors.affiliation: The Palm Beach Shoulder Service at Atlantis Orthopaedics, Palm Beach Gardens, FL, USA; Division of Orthopaedic Surgery, Department of Surgery, Nova-Southeastern University College of Osteopathic Medicine, Davie, FL, USA. Electronic address: h.routman@atlantisortho.com.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Routman
authors.affiliation: The Palm Beach Shoulder Service at Atlantis Orthopaedics, Palm Beach Gardens, FL, USA.
authors.forename: Logan R
authors.initials: LR
authors.lastname: Israel
authors.affiliation: The Palm Beach Shoulder Service at Atlantis Orthopaedics, Palm Beach Gardens, FL, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Moor
authors.affiliation: The Palm Beach Shoulder Service at Atlantis Orthopaedics, Palm Beach Gardens, FL, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Boltuch
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007902:Length of Stay; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D019990:Perioperative Care; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003509:Cyclohexanecarboxylic Acids; D008081:Liposomes; D009294:Narcotics; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003907:Dexamethasone; D002045:Bupivacaine
keywords: length of stay; liposomal bupivacaine; multimodal pain management; narcotic use; pain control; pain management; shoulder replacement