Department of Anesthesia Surgery, Zhejiang Hospital, Hangzhou, China.
Department of Anesthesia Surgery, Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China.
J Shoulder Elbow Surg. 2022 Sep;31(9):1957-1968. doi: 10.1016/j.jse.2022.02.037. Epub 2022 Apr 14.
Total shoulder arthroplasty and rotator cuff repair surgery result in considerable postoperative pain. Optimal postoperative pain management based on a multidisciplinary approach is necessary to promote early postoperative rehabilitation. The purpose of this study was to compare liposomal bupivacaine (LB) with traditional, non-LB agents after total arthroplasty or rotator cuff repair surgery.
Two independent authors searched the PubMed Central, Google Scholar, and Cochrane Library websites for suitable articles. We included randomized controlled trials comparing outcomes after the administration of LB and non-LB agents for rotator cuff repair or total shoulder arthroplasty. The outcome measures for our meta-analysis were visual analog scale (VAS) pain scores at 24 and 48 hours after surgery, opioid consumption 24 and 48 hours after surgery, hospital stay duration, and complications within 48 hours after surgery. We used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool to assess the degree of evidence for the outcomes, and we used the Cochrane risk-of-bias assessment tool to assess the risk of bias.
The current meta-analysis comprised 11 randomized controlled studies with 846 subjects. Seven studies used local infiltration to administer LB, and 3 used a block. Our pooled analysis results showed no significant difference in VAS pain scores at 24 hours after surgery (standardized mean difference [SMD], -0.27; 95% confidence interval [CI], -0.55 to 0.01; prediction interval, -1.25 to 0.70), VAS pain scores at 48 hours after surgery (SMD, -0.18; 95% CI, -0.46 to 0.09; prediction interval, -1.10 to 0.73), opioid consumption at 24 hours after surgery (SMD, 0.04; 95% CI, -0.27 to 0.34; prediction interval, -1.01 to 1.09), and opioid consumption at 48 hours after surgery (SMD, 0.10; 95% CI, -0.44 to 0.64; prediction interval, -1.76 to 1.96) between the LB and non-LB groups. The LB and non-LB groups had similar hospital stay durations (SMD, -0.38; 95% CI, -1.51 to 0.74; prediction interval, -14.7 to 13.9) and adverse events (risk ratio, 0.89; 95% CI, 0.42 to 1.36) following the shoulder procedures. The level of evidence was low according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) analysis.
Our meta-analysis provides evidence indicating that LB is similar to non-LB agents in terms of overall pain relief and opioid requirements. The duration of hospital stay and complication rates were also similar in the 2 groups. Future well-designed and adequately powered randomized controlled studies are needed to confirm our results and to be able to recommend LB for various types of shoulder operations.
全肩关节置换术和肩袖修复手术后会产生相当大的术后疼痛。基于多学科方法的最佳术后疼痛管理对于促进术后早期康复是必要的。本研究的目的是比较全肩关节置换术或肩袖修复手术后使用脂质体布比卡因（LB）与传统非 LB 药物的效果。
两位独立作者在 PubMed Central、Google Scholar 和 Cochrane Library 网站上搜索了合适的文章。我们纳入了比较 LB 与非 LB 药物在肩袖修复或全肩关节置换术后疗效的随机对照试验。我们的荟萃分析的结局指标包括术后 24 小时和 48 小时视觉模拟评分（VAS）疼痛评分、术后 24 小时和 48 小时阿片类药物用量、住院时间和术后 48 小时内的并发症。我们使用 GRADE（推荐评估、制定与评价）工具评估结局的证据等级，使用 Cochrane 偏倚风险评估工具评估偏倚风险。
当前的荟萃分析共纳入了 11 项随机对照研究，涉及 846 名患者。7 项研究使用局部浸润给予 LB，3 项研究使用阻滞。我们的汇总分析结果显示，术后 24 小时 VAS 疼痛评分（标准化均数差 [SMD]，-0.27；95%置信区间 [CI]，-0.55 至 0.01；预测区间，-1.25 至 0.70）、术后 48 小时 VAS 疼痛评分（SMD，-0.18；95%CI，-0.46 至 0.09；预测区间，-1.10 至 0.73）、术后 24 小时阿片类药物用量（SMD，0.04；95%CI，-0.27 至 0.34；预测区间，-1.01 至 1.09）和术后 48 小时阿片类药物用量（SMD，0.10；95%CI，-0.44 至 0.64；预测区间，-1.76 至 1.96）在 LB 组和非 LB 组之间没有显著差异。LB 组和非 LB 组的住院时间（SMD，-0.38；95%CI，-1.51 至 0.74；预测区间，-14.7 至 13.9）和不良事件（风险比，0.89；95%CI，0.42 至 1.36）也相似。根据 GRADE（推荐评估、制定与评价）分析，证据等级较低。
我们的荟萃分析结果表明，LB 在缓解总体疼痛和阿片类药物需求方面与非 LB 药物相似。两组的住院时间和并发症发生率也相似。需要未来设计良好且充分有力的随机对照试验来证实我们的结果，并能够推荐 LB 用于各种类型的肩部手术。
