Abstract
Background The purpose of this study was to investigate if the addition of liposome bupivacaine (LB) to an interscalene block (ISB) had an effect on the number of patients with surgical- or block-related complications. Methods This was a single-center retrospective chart view performed by identifying patients who received an ISB from January 1, 2014, through April 26, 2018, at the University of Minnesota. 1,518 patients were identified who received an ISB (LB = 784, nonliposomal bupivacaine = 734). Patients were divided into two groups those who did receive liposome bupivacaine in their ISB and those who did not receive liposome bupivacaine in their ISB. Medical records were individually reviewed for surgical procedure, block medications, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 and within 30 days, readmissions within 30 days, and emergency room visits for complications within 3 and 30 days. Results There was no significant difference in the number of patients with surgical or anesthetic complications. Only phone calls for pain within 3 days were significantly different. The LB group had 3.2% of patients call compared to 5.6% in the nonliposomal bupivacaine group (aOR = 1.71 (95% CI: 1.04–2.87), p=0.036). We found no significant difference in any of the other secondary outcomes. Conclusions The use of LB in an ISB demonstrated no significant difference compared to nonliposomal bupivacaine in numbers of complications, emergency room visits, and readmissions.
Highlights
Patients commonly experience moderate-to-severe postoperative pain after undergoing shoulder surgery [1]
Patients were divided into liposomal bupivacaine and nonliposomal bupivacaine groups for statistical analysis. ose patients in whom the medications used for the block were recorded but volumes of medications used were not recorded were included in the study. ose patients in whom there was no mention of what medication was used for their interscalene block (ISB) were excluded in the final analysis. e primary outcome of this study was the number of patients with postoperative block and surgical complications seen in each group
Compared to nonliposomal bupivacaine single shot ISBs, there was no difference in the number of patients with block- or surgical-related complications
Summary
Patients commonly experience moderate-to-severe postoperative pain after undergoing shoulder surgery [1]. We wanted to understand if the use of liposomal bupivacaine in an ISB impacted the number of readmissions, phone calls, or emergency department (ED) visits for patients undergoing shoulder surgery. We hypothesized that there would be no difference in postoperative complications, pain phone calls, and ED visits between blocks performed with added LB versus those without. Electronic medical charts were individually reviewed for surgical procedure, block medications used, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 days and within 30 days, readmissions within 30 days, and emergency room visits for pain, opioids, or block-related complications within 3 days and within 30 days. All analyses completed with R version 3.5.1 [18], and Firth’s logistic regression used the logistf package [19]
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