Hardrick Jaden, Ifarraguerri Anna M, Collins Michael S, Trofa David P, Fleischli James E, Hamid Nady, Siparsky Patrick N, Saltzman Bryan M
OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207, United States.
OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207, United States; OrthoCarolina Research Institute, 2001 Vail Ave, #300, Charlotte, NC 28207, United States; Atrium Health - Musculoskeletal Institute, 2001 Vail Ave, 6th Floor MSKI Suite, Charlotte, NC 28207, United States.
Orthop Traumatol Surg Res. 2025 Feb 17:104190. doi: 10.1016/j.otsr.2025.104190.
Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.
A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.
Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD -3.45, 95% CI [-5.20, -1.60]; P = 0.0003 and SMD -2.39, 95% CI [-4.01, -0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD -4.66; 95% CI, -7.95 to -1.36; p = 0.006; SMD -3.77; 95% CI, -5.69 to -1.85; p = 0.0001, SMD -3.34 95% CI [-5.13, -1.56]; p = 0.0002, and SMD -3.43; 95% CI, -5.74 to -1.12; p = 0.004, respectively).
LB moderately decreased pain scores 24-72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.
I.
肌间沟神经阻滞（ISNBs）可缩短关节镜下肩袖修补术（ARCR）后的住院时间、减轻术后疼痛并减少阿片类药物的使用。使用布比卡因等麻醉剂进行肌间沟神经阻滞会伴有剧烈的反弹痛，而脂质体布比卡因（LB）可能会将疼痛缓解时间延长至72小时，并减少阿片类药物的使用。本系统评价和荟萃分析的目的是比较脂质体布比卡因与传统肌间沟神经阻滞在ARCR术后疼痛管理和阿片类药物使用方面的疗效。
按照PRISMA指南进行系统评价，检索时间从开始到2024年3月。纳入比较脂质体布比卡因和传统肌间沟神经阻滞在ARCR术后疼痛管理和阿片类药物使用方面的随机对照试验。对每个结局指标的荟萃分析在森林图中进行概述，详细列出连续变量的标准平均差（SMD）。
从5篇文章中提取了362例接受ARCR患者的数据，其中196例接受脂质体布比卡因治疗，166例接受对照非脂质体布比卡因肌间沟神经阻滞。脂质体布比卡因干预组在术后第1天和第2天的疼痛评分显著低于对照组（SMD -3.45，95% CI [-−5.20, -1.60]；P = 0.0003和SMD -2.39，95% CI [-4.01, -0.77]；P = 0.004）。脂质体布比卡因组在术后第0天、第1天、第2天和第3天的口服吗啡当量剂量消耗显著低于对照组（SMD -4.66；95% CI，-7.95至-1.36；p = 0.006；SMD -3.77；95% CI，-5.69至-1.85；p = 0.0001，SMD -3.34 95% CI [-5.13, -1.56]；p = 0.0002，以及SMD -3.43；95% CI，-5.74至-1.12；p = 0.004）。
与对照肌间沟神经阻滞组相比，脂质体布比卡因在ARCR术后24 - 72小时适度降低了疼痛评分，并在长达96小时内减少了阿片类药物的使用。然而，阿片类药物使用的临床差异可能不会转化为患者的益处，也不能证明成本增加是合理的。
I级。
