title: Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty.
abstract: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate.
  
  
  
  In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs.
  
  
  
  Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42.
  
  
  
  The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use.
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee.
authors.forename: William J
authors.initials: WJ
authors.lastname: Weller
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Azzam
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Azar
authors.affiliation: Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Throckmorton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000191:economics; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000191:economics; D002404:Catheterization; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000191:economics; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D007902:Length of Stay; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012782:Shoulder
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D008081:Liposomes; D009020:Morphine; D002045:Bupivacaine; D004837:Epinephrine; D020910:Ketorolac
keywords: complications; cost analysis; interscalene catheter; liposomal bupivacaine; total shoulder arthroplasty