Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial

Abildgaard, Jeffrey T.; Lonergan, Keith T.; Tolan, Stefan J.; Kissenberth, Michael J.; Hawkins, Richard J.; Washburn, Richard A.; Adams, Kyle; Long, Catherine D.; Shealy, E. Carlisle; Motley, Jay R.; Tokish, John M.

doi:10.1016/j.jse.2017.03.012

Cited by 69 publications

(64 citation statements)

References 33 publications

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“…A slow-release mechanism involving reorganization of the barrier lipid membranes is sustained for up to 92 h with concomitant pain control for up to 72 h, as compared to 7-12 h with standard bupivacaine. Studies show bupivacaine decreased pain compared to placebo, the use of opioids and the hospital costs (Yeung et al 2018;Mazloomdoost et al 2017;Sabesan et al 2017;Declaire et al 2017;Smith et al 2017;Mcgraw-tatum et al 2017;Abildgaard et al 2017;Alijanipour et al 2016;Davidovitch et al 2017). Although the liposomal bupivacaine is not a nanoparticle (3-30 μm mean diameter), it is mentioned here because it is one of the most recent liposomal formulations approved.…”

Section: Pain Management: Bupivacainementioning

confidence: 99%

Nanomedicine review: clinical developments in liposomal applications

et al. 2019

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Background Many conventional drugs exhibit poor pharmacokinetics, limited bioavailability and a high toxicity, all of which restrain their use. To overcome these issues and improve the therapeutic indexes of the drug, the emergent fields of nanotechnology and nanomedicine have made significant progress in detection, diagnosis and treatment of several diseases at clinical level (Li et al. 2014; Yingchoncharoen et al. 2016; Signorell et al. 2018). In fact, thanks to nanoparticles and liposomes, it has been possible to decrease the toxicity and improve the pharmacokinetics parameters, such as distribution, increased circulation time, targeted controlled release, increased intracellular concentration, and

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Section: Pain Management: Bupivacainementioning

confidence: 99%

Nanomedicine review: clinical developments in liposomal applications

et al. 2019

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“… 15 – 17 Finally, of the 150 studies, four RCTs and three retrospective studies published between 2016 and 2017 were included in our meta-analysis ( Figure 1 ). 18 – 20 , 25 – 28 …”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of the included studies are summarized in Table 1 . We identified four RCTs 20 , 25 , 27 , 28 and three retrospective controlled studies 18 , 19 , 26 in our study. The trials compared LB vs INB for pain control after TSA.…”

Section: Resultsmentioning

confidence: 99%

“…Seven reports included the pain scores at 24 hours after TSA. 18 – 20 , 25 – 28 Obvious heterogeneity was found among these studies ( I 2 =72%, P =0.001); hence, a random-effects model was used. After pooling the results, we found that the pain scores at 24 hours after TSA were similar between the LB group and the INB group (SMD =−0.17, 95% CI=−0.48 to 0.13, P =0.26; Figure 2D ).…”

Section: Resultsmentioning

confidence: 99%

“…The pain scores at POD 1 after TSA were provided in four studies. 19 , 20 , 25 , 28 A fixed-effects model was used because of low heterogeneity ( I 2 =0%, P =0.48). The difference in pain scores at POD 1 between the LB and INB groups was not statistically significant according to our analysis (SMD =0.10, 95% CI=−0.15 to 0.35, P =0.42; Figure 2E ).…”

Section: Resultsmentioning

confidence: 99%

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

Sun¹,

Li²,

Wang³

et al. 2018

JPR

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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.

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