A comparison of liposomal bupivacaine to standard ropivacaine used in interscalene blocks for patients undergoing total shoulder arthroplasty.
With the increasing incidence of total shoulder arthroplasty (TSA) being performed worldwide, there is a growing effort to reduce postoperative pain, the consumption of opioids (oral morphine equivalents [OMEs]), and subsequent in hospital length of stay. Although perioperative pain control regimens...
| Publicado en: | Seminars in Arthroplasty: JSES Vol. 31; no. 1; pp. 117 - 125 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
W B Saunders
May2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=149712168&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 149712168 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10454527 6N6D jtl: Seminars in Arthroplasty: JSES issn: 10454527 maglogo: N pubinfo: dt: May2021 vid: 31 iid: 1 pid: 1351 pub: W B Saunders place: Philadelphia, Pennsylvania artinfo: ui: 149712168 149712168 149712168 10.1053/j.sart.2020.11.003 149712168 ppf: 117 ppct: 8 formats: tig: atl: A comparison of liposomal bupivacaine to standard ropivacaine used in interscalene blocks for patients undergoing total shoulder arthroplasty. aug: au: Dawes, Alexander M. Spencer, Corey C. Guisse, Ndeye Farley, Kevin X. Daly, Charles A. Wagner, Eric R. Gottschalk, Michael B. affil: Emory University Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Atlanta, GA, USA sug: subj: Arthroplasty, Replacement, Shoulder Bupivacaine Therapeutic Use Membranes, Artificial Ropivacaine Therapeutic Use Brachial Plexus Block Methods Quality Improvement Human Treatment Outcomes Evaluation Comparative Studies Surgical Patients Prospective Studies Health Facilities United States ab: With the increasing incidence of total shoulder arthroplasty (TSA) being performed worldwide, there is a growing effort to reduce postoperative pain, the consumption of opioids (oral morphine equivalents [OMEs]), and subsequent in hospital length of stay. Although perioperative pain control regimens have been widely studied in patients undergoing TSA, patients continue to consume a significant quantity of opioids after surgery. In the era of an opioid epidemic, novel methods for the improvement of perioperative pain control is of utmost importance. The aim of this quality improvement initiative was to evaluate the effect of liposomal bupivacaine (LB) versus ropivacaine (RP) in interscalene peripheral nerve blockade (IPNB) in patients undergoing TSA. This quality improvement initiative prospectively evaluated a consecutive group of patients undergoing TSA from June 2017 to September 2019. Patients were included if they underwent either an anatomic or reverse shoulder arthroplasty at a single institution by 1 of 2 fellowship trained surgeons. Patients were divided in to 2 temporal cohorts based on the US Food and Drug administration's approval of LB. Patients who received a RPIPNB were in the control group, while those who received a LBIPNB were in the treatment group. Outcome measures studied included average visual analog pain scores (VAS) at 24 and 48 hours in the hospital, OME's, and length of stay. A total of 114 patients underwent TSA and met the inclusion criteria to be included in the analysis: 58 received RPIPNB and 56 received LBIPNB. The cohorts did not demonstrate any statistically different attributes (eg, age, sex, dominance, smoking status, psychiatric disorders, diabetes, HTN, or ASA class). Difference in 24 hour and 48 hour VAS pain scores was significantly improved in the LBIPNB group as compared to the RPIPNB group (2.46 vs. 0.72, and 2.02 and −0.41, respectively P <.01). Difference in OME's and length of stay were not statistically significant. Despite significantly improved pain scores at 24 hours and 48 hours, patients who received LBIPNB did not demonstrate a statistically significant improvement in LOS or quantity of OME's consumed. The discrepancy between subjective numeric pain scores and objective healthcare metrics is likely multifactorial, and brings to light the difficulty in determining the value of new pain regimens. In lieu of these findings, it is difficult to endorse or reject the use of LBIPNB in TSA. Without further studies demonstrating improved efficacy in reduction of opioid consumption and LOS, given the additional expense of the drug, its continued use remains uncertain. Level III. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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