Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: a systematic review and meta-analysis

Abstract

ObjectiveControversy still exists regarding the efficiency and safety of liposomal bupivacaine (LB) vs interscalene nerve block (INB) for pain management after total shoulder arthroplasty (TSA). The aim of the present meta-analysis was to perform a relatively credible and overall assessment to compare the efficiency and safety of LB-based infiltration vs INB for pain management after TSA.MethodsThe PubMed, Cochrane Library, Web of Science, and EMBASE were systematically searched. Only studies published up to March 2018 comparing LB vs INB for pain control after TSA were included. The primary outcome extracted from the studies was postoperative pain score at different periods. The secondary outcomes included total opioid consumption, length of hospital stay, and complications.ResultsSeven studies with 707 patients were included in this study. No statistically significant difference was observed between the LB and INB groups in pain scores at 8 hours, 12 hours, 24 hours, postoperative day (POD) 1, and POD 2. The two groups also showed comparable total opioid consumption at POD 0, POD 1, POD 2, and length of hospital stay. The LB group had a significantly higher pain score at 4 hours (standard mean difference =0.65, 95% CI=0.07 to 1.24, P=0.03) but a lower occurrence rate of complications than did the INB group (OR =0.51, 95% CI=0.28 to 0.91, P=0.02).ConclusionThis meta-analysis revealed that INB provides excellent analgesic effects within 4 hours after TSA, while patients treated with LB infiltration experienced significantly less occurrence rate of complications after TSA. In general, both approaches provide similar overall pain relief and have similar opioid consumption after TSA, with no significant difference in the length of hospital stay. Nevertheless, more high-quality randomized controlled trails with long-term follow-up are still required to make the final conclusion.

Osmotically Balanced, Large Unilamellar Liposomes for Sustained Bupivacaine Release: From the Development of Liposomes to Their in Vivo Application

“…22 However, controversies exist regarding its analgesic e cacy. 1,23 Many studies have failed to detect the differences in analgesic effects between liposomal bupivacaine and traditional long-term local anesthetics, especially at the 24 h mark after surgery 24,25 . Thus, this study aimed to explore the analgesic effect of the developed liposomal bupivacaine in detail.…”

Osmotically balanced, large unilamellar liposomes that enable sustained bupivacaine release for prolonged pain relief in in vivo rat models

“…However, controversies exist regarding its analgesic efficacy 1 , 23 . Many studies have failed to detect the differences in analgesic effects between liposomal bupivacaine and traditional long-term local anesthetics, especially at the 24 h mark after surgery 24 , 25 . Thus, this study aimed to explore the analgesic effect of the developed liposomal bupivacaine in detail.…”

The efficacy and safety of interscalene blockade versus local infiltration analgesia in primary total shoulder arthroplasty?

“…However, the author mistakenly used a retrospective study [15] as RCT in their study. In the study of Sun et al, [19] the authors included 4 RCTs [ 4 , 6 , 16 , 20 ] and 3 retrospective studies [ 13 – 15 ] to compare ISB alone with LIA alone and found that both techniques provide similar overall pain relief and have similar opioid consumption, while patients treated with LIA experienced significantly less occurrence rate of complications after TSA. However, they contained some methodological shortcomings, data extraction, limited sample size, and high heterogeneity.…”