Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis

Zeng Yan, Zong Chen, Chuangen Ma, Zeng Yan, Zong Chen, Chuangen Ma

Abstract

Background: Postoperative pain control after total shoulder arthroplasty (TSA) can be challenging. Liposomal bupivacaine and interscalene nerve block are 2 common pain control protocol for TSA patients. However, whether liposomal bupivacaine was superior than interscalene nerve block was unknown. This meta-analysis aimed to illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain control in patients undergoing TSA.

Methods: In May 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TSA in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, and 2 weeks, total morphine consumption at 24 hours, and the length of hospital stay. Software of Stata 12.0 was used for pooling the final outcomes.

Results: Five clinical studies with 573 patients (liposomal bupivacaine group = 239, interscalene nerve block group = 334) were ultimately included in the meta-analysis. There was no significant difference between the VAS at 4 hours, 8 hours, and 2 weeks between liposomal bupivacaine group and interscalene nerve block group (P > .05). Compared with interscalene nerve block group, liposomal bupivacaine was associated with a reduction of VAS score at 12 hours, 24 hours by appropriately 3.31 points and 6.42 points respectively on a 100-point VAS. Furthermore, liposomal bupivacaine was associated with a significantly reduction of the length of hospital stay by appropriately by 0.16 days compared with interscalene nerve block group.

Conclusion: Current meta-analysis indicates that compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and the length of hospital stay. However, studies with more patients and better-designed methods are needed to establish the optimal regimen and the safety of liposomal bupivacaine in TSA patients.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of study search and inclusion criteria.
Figure 2
Figure 2
Risk of bias summary of included randomized controlled trials. +, no bias; –, bias; and ?, bias unknown.
Figure 3
Figure 3
The risk of bias graph.
Figure 4
Figure 4
Forest plots of the included studies comparing the visual analogue scale (VAS) at 4 hours.
Figure 5
Figure 5
Forest plots of the included studies comparing the visual analogue scale (VAS) at 8 hours.
Figure 6
Figure 6
Forest plots of the included studies comparing the visual analogue scale (VAS) at 12 hours.
Figure 7
Figure 7
Forest plots of the included studies comparing the visual analogue scale (VAS) at 24 hours.
Figure 8
Figure 8
Forest plots of the included studies comparing the visual analogue scale (VAS) at 2 week.
Figure 9
Figure 9
Forest plots of the included studies comparing the total morphine consumption at 24 hours.
Figure 10
Figure 10
Forest plots of the included studies comparing the length of hospital stay.
Figure 11
Figure 11
Sensitivity analysis of the visual analogue scale (VAS) at 8 hours.
Figure 12
Figure 12
Sensitivity analysis of the visual analogue scale (VAS) at 2 week.
Figure 13
Figure 13
Sensitivity analysis of the total morphine consumption.

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Source: PubMed

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