Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Department of Anesthesiology, Duke University, Durham, NC, USA.
J Shoulder Elbow Surg. 2022 Oct;31(10):e473-e479. doi: 10.1016/j.jse.2022.03.013. Epub 2022 Apr 25.
Multimodal pain regimens in total shoulder arthroplasty (TSA) now include regional anesthetic techniques. Historically, regional anesthesia for extended postoperative pain control in TSA was administered using a continuous interscalene catheter (CIC). Liposomal bupivacaine (LB) is used for its potential for similar pain control and fewer complications compared with indwelling catheters. We evaluated the efficacy of interscalene LB compared with a CIC in postoperative pain control for patients undergoing TSA.
This was a retrospective cohort study at a tertiary-care academic medical center including consecutive patients undergoing primary anatomic or reverse TSA from 2016 to 2020 who received either single-shot LB or a CIC for perioperative pain control. Perioperative and outcome variables were collected. The primary outcome was postoperative pain control, whereas the secondary outcome was health care utilization.
The study included 565 patients, with 242 in the CIC cohort and 323 in the LB cohort. Demographic characteristics including sex (P = .99) and race (P = .81) were similar between the cohorts. The LB cohort had significantly lower mean pain scores at 24 hours (3 vs. 2, P < .001) and 36 hours (3 vs. 2, P < .001) postoperatively. The CIC cohort showed a higher percentage of patients experiencing a pain score of 9 or 10 postoperatively (29% vs. 17%, P = .001), whereas the LB cohort had a significantly greater proportion of opioid-free patients (32% vs. 10%, P < .001). Additionally, a greater proportion of CIC patients required opioid escalation to patient-controlled analgesia (7% vs. 2%, P = .002). The CIC cohort experienced a greater length of stay (2.3 days vs. 2.1 days, P = .01) and more 30-day emergency department visits (5% vs. 2%, P = .038).
LB demonstrated lower mean pain scores at 24 and 36 hours postoperatively and lower rates of severe postoperative pain. Additionally, LB patients showed significantly higher rates of opioid-free pain regimens. These results suggest that as part of a multimodal pain regimen in primary shoulder arthroplasty, LB may provide greater reductions in pain and opioid use when compared with CICs.
全肩关节置换术（TSA）中的多模式疼痛方案现在包括区域麻醉技术。从历史上看，为了延长 TSA 术后的疼痛控制，使用连续的肌间沟导管（CIC）进行区域麻醉。与留置导管相比，脂质体布比卡因（LB）具有潜在的相似的疼痛控制和更少的并发症。我们评估了 LB 与 CIC 在 TSA 术后疼痛控制中的效果。
这是一项回顾性队列研究，在一家三级保健学术医疗中心进行，纳入了 2016 年至 2020 年间接受过单次 LB 或 CIC 用于围手术期疼痛控制的原发性解剖或反向 TSA 的连续患者。收集围手术期和结果变量。主要结果是术后疼痛控制，次要结果是医疗保健利用。
研究纳入了 565 例患者，其中 CIC 组 242 例，LB 组 323 例。两组患者的人口统计学特征（性别：P=0.99；种族：P=0.81）相似。LB 组术后 24 小时（3 分 vs. 2 分，P<0.001）和 36 小时（3 分 vs. 2 分，P<0.001）的平均疼痛评分明显较低。CIC 组术后有更高比例的患者（29% vs. 17%，P=0.001）疼痛评分达到 9 或 10，而 LB 组有更高比例的无阿片类药物患者（32% vs. 10%，P<0.001）。此外，CIC 组患者需要阿片类药物升级至患者自控镇痛的比例更大（7% vs. 2%，P=0.002）。CIC 组的住院时间（2.3 天 vs. 2.1 天，P=0.01）和 30 天内急诊就诊率（5% vs. 2%，P=0.038）更高。
LB 在术后 24 小时和 36 小时的平均疼痛评分更低，术后严重疼痛的发生率更低。此外，LB 患者无阿片类药物的疼痛治疗方案显著更高。这些结果表明，在原发性肩部关节炎的多模式疼痛方案中，LB 与 CIC 相比，可能会降低疼痛和阿片类药物的使用。
