Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty: A meta-analysis of randomized control trails

Xiuling Cao, Fang Pan, Xiuling Cao, Fang Pan

Abstract

Background: This meta-analysis aimed to compare the efficiency and safety of liposomal bupivacaine infiltration and interscalene nerve block for pain control after total shoulder arthroplasty.

Methods: A systematic search was performed in Medline (1966 to May 2017), PubMed (1966 to May 2017), Embase (1980 to May 2017), ScienceDirect (1985 to May 2017) and the Cochrane Library. Only randomized controlled trials (RCTs) were included. Reported surgical outcomes, including visual analogue scale (VAS) scores, opioid consumption, length of stay, and postoperative adverse effects including the risk of nausea and vomiting. Meta-analysis was performed using Stata 11.0 software.

Results: Four RCTs including 510 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of VAS score at 12 hours (standard mean difference [SMD] = 0.272, 95% CI: -0.150 to 0.695, P = .207), 24 hours (SMD = -0.056, 95% CI: -0.458 to 0.346, P = 0.785), and 48 hours (SMD = 0.183, 95% CI: -0.148 to 0.513, P = .278). Liposomal bupivacaine infiltration groups required an equivalent amount of opioids at postoperative 12 hours (SMD = -0.039, 95% CI: -0.222 to 0.143, P = .672), 24 hours (SMD = 0.046, 95% CI: -0.136 to 0.228, P = .618) and 48 hours (SMD = -0.025, 95% CI: -0.207 to 0.157, P = .785).

Conclusion: Liposomal bupivacaine infiltration provides equivalent postoperative pain control compared with interscalene nerve block following total shoulder arthroplasty. Both of them can reduce the consumption of opioids without severe adverse effects. More high-quality RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of liposomal bupivacaine infiltration with interscalene nerve block.

Conflict of interest statement

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

Figures

Figure 1
Figure 1
Search results and the selection procedure.
Figure 2
Figure 2
Forest plot diagram showing VAS scores at 12 h following TSA. TSA = total shoulder arthroplasty, VAS = visual analogue scale.
Figure 3
Figure 3
Forest plot diagram showing VAS scores at 24 h following TSA. TSA = total shoulder arthroplasty, VAS = visual analogue scale.
Figure 4
Figure 4
Forest plot diagram showing VAS scores at 48 h following TSA. TSA = total shoulder arthroplasty, VAS = visual analogue scale.
Figure 5
Figure 5
Forest plot diagram showing opioid consumption at 12 h following TSA. TSA = total shoulder arthroplasty.
Figure 6
Figure 6
Forest plot diagram showing opioid consumption at 24 h following TSA. TSA = total shoulder arthroplasty.
Figure 7
Figure 7
Forest plot diagram showing opioid consumption at 48 h following TSA. TSA = total shoulder arthroplasty.
Figure 8
Figure 8
Forest plot diagram showing LOS following TSA. LOS = length of stay, TSA = total shoulder arthroplasty.
Figure 9
Figure 9
Forest plot diagram showing incidence of nausea following TSA. TSA = total shoulder arthroplasty.
Figure 10
Figure 10
Forest plot diagram showing incidence of vomiting following TSA. TSA = total shoulder arthroplasty.

References

    1. Izquierdo R, Voloshin I, Edwards S, et al. Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg 2010;18:375–82.
    1. Jain NB, Yamaguchi K. The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg 2014;23:1905–12.
    1. Hansen CA, Inacio MC, Pratt NL, et al. Chronic use of opioids before and after total knee arthroplasty: a retrospective cohort study. J Arthroplasty 2017;32:811.e1–7.e1.
    1. Ilfeld BM, Wright TW, Enneking FK, et al. Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study. Reg Anesth Pain Med 2005;30:429–33.
    1. Ramirez MA, Ramirez JM, Murthi AM. Multimodal local infiltration analgesia in total shoulder replacement. Pain Manag 2013;3:253–5.
    1. Koff MD, Cohen JA, McIntyre JJ, et al. Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis. Anesthesiology 2008;108:325–8.
    1. Bilbao Ares A, Sabate A, Porteiro L, et al. Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital. Revista espanola de anestesiologia y reanimacion 2013;60:384–91.
    1. Ramamoorthy KG. Local infiltration analgesia following total knee arthroplasty. Indian J Anaesth 2012;56:208–9.
    1. Sculco TP. Local infiltration analgesia reduced postoperative morphine consumption and provided better pain relief than intrathecal morphine after total knee arthroplasty. J Bone Joint Surg Am 2012;94:1511–3.
    1. Cotta BH, Welliver C, Brahmamdam A, et al. Long-acting liposomal bupivacaine decreases inpatient narcotic requirements in men undergoing penile prosthesis implantation. Turk J Urol 2016;42:230–4.
    1. Ma J, Zhang W, Yao S. Liposomal bupivacaine infiltration versus femoral nerve block for pain control in total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 2016;36(part A):44–55.
    1. Okoroha KR, Keller RA, Marshall NE, et al. Liposomal bupivacaine versus femoral nerve block for pain control after anterior cruciate ligament reconstruction: a prospective randomized trial. Arthroscopy 2016;32:1838–45.
    1. Abildgaard JT, Lonergan KT, Tolan SJ, et al. Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial. J Shoulder Elbow Surg 2017;26:1175–81.
    1. Namdari S, Nicholson T, Abboud J, et al. Randomized controlled trial of interscalene block compared with injectable liposomal bupivacaine in shoulder arthroplasty. J Bone Joint Surg Am 2017;99:550–6.
    1. Okoroha KR, Lynch JR, Keller RA, et al. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: a prospective randomized trial. J Shoulder Elbow Surg 2016;25:1742–8.
    1. Weller WJ, Azzam MG, Smith RA, et al. Liposomal bupivacaine mixture has similar pain relief and significantly fewer complications at less cost compared to indwelling interscalene catheter in total shoulder arthroplasty. J Arthroplasty 2017;Mar 16. pii: S0883-5403(17)30219-X. doi: 10.1016/j.arth.2017.03.017. [Epub ahead of print].
    1. Hamilton TW, Athanassoglou V, Trivella M, et al. Liposomal bupivacaine peripheral nerve block for the management of postoperative pain. Cochrane Database Syst Rev 2016;8:CD011476.doi: 10.1002/14651858.CD011476.pub2.
    1. Asche CV, Ren J, Kim M, et al. Local infiltration for postsurgical analgesia following total hip arthroplasty: a comparison of liposomal bupivacaine to traditional bupivacaine. Curr Med Res Opin 2017;33:1283–90.
    1. Meneghini RM, Bagsby D, Ireland PH, et al. Liposomal bupivacaine injection technique in total knee arthroplasty. J Knee Surg 2017;30:88–96.
    1. Wang X, Xiao L, Wang Z, et al. Comparison of peri-articular liposomal bupivacaine and standard bupivacaine for postsurgical analgesia in total knee arthroplasty: a systematic review and meta-analysis. Int J Surg 2017;39:238–48.
    1. Liu SQ, Chen X, Yu CC, et al. Comparison of periarticular anesthesia with liposomal bupivacaine with femoral nerve block for pain control after total knee arthroplasty: a PRISMA-compliant meta-analysis. Medicine 2017;96:e6462.
    1. Hannan CV, Albrecht MJ, Petersen SA, et al. Liposomal bupivacaine vs interscalene nerve block for pain control after shoulder arthroplasty: a retrospective cohort analysis. Am J Orthop 2016;45:424–30.
    1. Stundner O, Rasul R, Chiu YL, et al. Peripheral nerve blocks in shoulder arthroplasty: How do they influence complications and length of stay? Clin Orthop Relat Res 2014;472:1482–8.
    1. Abdallah FW, Halpern SH, Aoyama K, et al. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg 2015;120:1114–29.
    1. Misamore G, Webb B, McMurray S, et al. A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia. J Shoulder Elbow Surg 2011;20:308–14.
    1. Hida T, Yukawa Y, Ito K, et al. Intrathecal morphine for postoperative pain control after laminoplasty in patients with cervical spondylotic myelopathy. J Orthop Sci 2016;21:425–30.
    1. Kunopart M, Chanthong P, Thongpolswat N, et al. Effects of single shot femoral nerve block combined with intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after total knee arthroplasty. J Med Assoc Thai [Chotmaihet thangphaet] 2014;97:195–202.

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