Simovitch Ryan Wade, Hernandez Thomas, YaDeau Jacques T, Grant Michael C, Pociask Christopher, Ouanes Jean-Pierre P
Hospital for Special Surgery Florida, West Palm Beach, Florida.
Jupiter Outpatient Surgery Center, Jupiter, Florida.
JB JS Open Access. 2022 Apr 4;7(2). doi: 10.2106/JBJS.OA.21.00122. eCollection 2022 Apr-Jun.
Brachial plexus blockade is utilized for pain control during arthroscopic rotator cuff repair. The purpose of the present study was to evaluate brachial plexus blockade with liposomal bupivacaine plus bupivacaine (LB+B) as compared with ropivacaine plus dexamethasone (R+D) for arthroscopic rotator cuff repair. Our hypothesis was that the use of LB+B would result in lower pain scores and opioid consumption as compared with R+D.
We performed a randomized controlled trial of 45 patients receiving ultrasound-guided brachial plexus blockade with LB+B and 44 patients receiving R+D prior to arthroscopic rotator cuff repair. The "worst pain" score in a 24-hour period, oral morphine equivalent dose (OMED), and overall benefit of analgesia score (OBAS) were recorded for 8 days following surgery.
Patient-reported "worst pain" was significantly lower in the LB+B group as compared with the R+D group on postoperative day 0 through day 5. OMED was significantly less for all 8 days studied, with an average cumulative 8-day OMED of 48.5 milligram equivalents in the LB+B group as compared with 190.1 milligram equivalents in the R+D group (p < 0.001). The OBAS score was significantly lower in the LB+B group as compared with R+D group on all postoperative days. The use of LB+B for brachial plexus blockade resulted in a 4% complication rate in a population of patients predominantly with American Society of Anesthesiologists (ASA) scores of 1 and 2.
The use of LB+B for brachial plexus blockade during arthroscopic rotator cuff repair was associated with a significant and sustained decrease in the "worst pain" score, opioid consumption, and OBAS compared with R+D. LB+B for brachial plexus blockade also exhibited a strong safety profile.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
臂丛神经阻滞用于关节镜下肩袖修复术中的疼痛控制。本研究的目的是评估脂质体布比卡因加布比卡因（LB+B）与罗哌卡因加地塞米松（R+D）用于关节镜下肩袖修复术时臂丛神经阻滞的效果。我们的假设是，与R+D相比，使用LB+B会导致更低的疼痛评分和阿片类药物消耗量。
我们进行了一项随机对照试验，45例患者在关节镜下肩袖修复术前接受超声引导下的臂丛神经阻滞并使用LB+B，44例患者接受R+D。记录术后8天内24小时的“最严重疼痛”评分、口服吗啡等效剂量（OMED）和镇痛总体效益评分（OBAS）。
在术后第0天至第5天，与R+D组相比，LB+B组患者报告的“最严重疼痛”明显更低。在研究的所有8天中，OMED明显更少，LB+B组8天平均累积OMED为48.5毫克当量，而R+D组为190.1毫克当量（p<0.001）。在所有术后天数，LB+B组的OBAS评分均明显低于R+D组。在主要为美国麻醉医师协会（ASA）评分1级和2级的患者群体中，使用LB+B进行臂丛神经阻滞的并发症发生率为4%。
与R+D相比，在关节镜下肩袖修复术中使用LB+B进行臂丛神经阻滞与“最严重疼痛”评分、阿片类药物消耗量和OBAS的显著且持续降低相关。LB+B用于臂丛神经阻滞也表现出良好的安全性。
治疗性I级。有关证据水平的完整描述，请参阅作者指南。
