Fares Mohamad Y, Daher Mohammad, Boufadel Peter, Khan Adam Z, Abboud Joseph A
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Southern California Permanente Medical Group, Panorama City, California, USA.
Am J Sports Med. 2025 Apr;53(5):1254-1263. doi: 10.1177/03635465241260255. Epub 2025 Jan 6.
Liposomal bupivacaine (LB) is a relatively novel anesthetic agent used in the management of postoperative pain in patients who have undergone shoulder surgery.
To explore the literature on LB in the setting of shoulder surgery and assess its efficacy and utility in managing postoperative pain.
Systematic review and meta-analysis; Level of evidence, 1.
PubMed, Cochrane, and Google Scholar (pp 1-20) were searched for articles published up to November 2023. Inclusion criteria consisted of randomized controlled trials comparing anesthetic modalities using LB with other anesthetic modalities using alternative drugs in patients who underwent shoulder surgery. Complications, pain levels in the first 24 hours postoperatively, and opioid consumption intraoperatively and in the first, second, and third 24 hours postoperatively were assessed.
A total of 15 randomized controlled trials were included in the meta-analysis. In 4 studies comparing periarticular injections of LB (196 patients) with nerve blocks of other anesthetic agents (201 patients), there was no significant difference in pain levels ( = .74) and complication rates ( = .37); however, intraoperative opioid consumption was significantly greater in patients with periarticular injections of LB ( = .005). In 3 studies comparing single-injection LB nerve blocks (83 patients) with interscalene nerve block catheters (102 patients) and in 8 studies comparing single-injection LB nerve blocks (311 patients) with other nerve blocks (308 patients), single-injection LB nerve blocks demonstrated clinical superiority. Single-injection LB nerve blocks resulted in significantly lower pain levels and lower opioid consumption in the first, second, and third 24 hours postoperatively compared with other single-injection nerve blocks and both single-injection nerve blocks and interscalene catheters combined.
LB is a promising anesthetic component with efficacy in providing analgesia after shoulder surgery. Single-injection LB nerve blocks were found to be superior in reducing pain levels and opioid consumption compared with other anesthetic modalities.
脂质体布比卡因（LB）是一种相对新型的麻醉剂，用于肩部手术后患者的术后疼痛管理。
探讨肩部手术中有关LB的文献，并评估其在管理术后疼痛方面的疗效和实用性。
系统评价和荟萃分析；证据等级，1级。
检索了截至2023年11月发表在PubMed、Cochrane和谷歌学术（第1 - 20页）上的文章。纳入标准包括随机对照试验，比较在接受肩部手术的患者中使用LB的麻醉方式与使用其他替代药物的麻醉方式。评估了并发症、术后24小时内的疼痛水平以及术中及术后第1、2和3个24小时内的阿片类药物消耗量。
荟萃分析共纳入15项随机对照试验。在4项研究中，比较关节周围注射LB（196例患者）与其他麻醉剂神经阻滞（201例患者），疼痛水平（P = 0.74）和并发症发生率（P = 0.37）无显著差异；然而，关节周围注射LB的患者术中阿片类药物消耗量显著更高（P = 0.00）。在3项研究中，比较单次注射LB神经阻滞（83例患者）与肌间沟神经阻滞导管（102例患者），以及在8项研究中，比较单次注射LB神经阻滞（311例患者）与其他神经阻滞（308例患者），单次注射LB神经阻滞显示出临床优势。与其他单次注射神经阻滞以及单次注射神经阻滞和肌间沟导管联合相比，单次注射LB神经阻滞在术后第1、2和3个24小时导致显著更低的疼痛水平和更低的阿片类药物消耗量。
LB是一种有前景的麻醉成分，在肩部手术后提供镇痛方面有效。与其他麻醉方式相比，单次注射LB神经阻滞在降低疼痛水平和阿片类药物消耗量方面更具优势。
