Single-shot liposomal bupivacaine interscalene nerve block provides equivalent pain relief compared to continuous catheter interscalene nerve block in total shoulder arthroplasty

Abstract

BackgroundThis study compares early postoperative pain control, narcotic usage, and cost in patients undergoing total shoulder arthroplasty with the use of either a single-shot liposomal bupivacaine interscalene nerve block (SS) or a continuous catheter interscalene nerve block (IC). MethodsTwo consecutive cohorts of patients undergoing primary anatomic or reverse total shoulder arthroplasty at different centers with different regional anesthesia protocols (SS vs. IC) were reviewed. Outcomes included pain on a numeric rating scale, narcotic consumption in milligram morphine equivalents, hospital length of stay, duration of nerve blockade, and complications. Block-related supply costs and an estimate of anesthesia professional fees are also reported. ResultsAmong 100 patients evenly divided between SS and IC, the difference in mean numeric rating scale pain scores on postoperative day 0 and 1 was statistically significant in favor of the SS group (1.2 vs. 2.5) but otherwise no difference was noted on postoperative day 2 or 3. There was no difference in milligram morphine equivalents or length of stay. The average duration of the nerve block was 49.8 hours in the SS group, and 84.0 hours in the IC group. SS was less costly than IC regional anesthesia. ConclusionLiposomal bupivacaine used for a single shot interscalene nerve block is as effective as an indwelling catheter for controlling postoperative pain after shoulder arthroplasty. In our system, SS was more cost effective. Level of evidenceLevel Ⅲ; Retrospective Cohort Design; Treatment Study