title: Perineural Liposomal Bupivacaine for Postoperative Pain Control in Patients Undergoing Upper Extremity Orthopedic Surgery: A Prospective and Randomized Pilot Study.
abstract: BACKGROUND
  Upper extremity surgery is commonly performed in the ambulatory setting and is associated with moderate to severe postoperative pain.
  
  
  METHODS
  Patients scheduled for upper extremity orthopedic surgery with a peripheral nerve block were randomized to receive either an ultrasound-guided single-injection supraclavicular block or ultrasound-guided median, ulnar, and radial nerve blocks (forearm blocks) performed at the level of the mid to proximal forearm with liposomal bupivacaine (Exparel) combined with a short-acting supraclavicular block. A sham block was performed in an attempt to blind enrollees in the control group. We administered the EuroQol 5D-5L questionnaire preoperatively and on postoperative days 1-3 and considered the results the primary outcome of our investigation. Block procedure times, postanesthesia care unit (PACU) length of stay, instances of nausea/vomiting, need for narcotic administration, and patient satisfaction were also assessed.
  
  
  RESULTS
  We observed no significant differences in postoperative EuroQol scores between the 2 groups and no significant differences in patient demographics, PACU length of stay, or side effects in the PACU. In some instances, the short-acting supraclavicular block resolved in the PACU, and these patients reported higher pain scores and required titration of analgesics prior to discharge.
  
  
  CONCLUSIONS
  Larger prospective studies are needed to determine the safety and efficacy of liposomal bupivacaine in patients undergoing upper extremity surgery. Liposomal bupivacaine is currently only approved for local anesthetic infiltration use.
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: José R
authors.initials: JR
authors.lastname: Soberón
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: William
authors.initials: W
authors.lastname: Ericson-Neilsen
authors.affiliation: Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Sisco-Wise
authors.affiliation: Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Mariella
authors.initials: M
authors.lastname: Gastañaduy
authors.affiliation: Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: David E
authors.initials: DE
authors.lastname: Beck
keywords: Anesthetics–local; brachial plexus block; nerve block; orthopedics; pain–postoperative; ulnar nerve