Liposomal Bupivacaine + Bupivacaine Versus Bupivacaine Interscalene Nerve Block Effect on Pain After Rotator Cuff Repair: A Randomized Control Trial.

Abstract

Interscalene nerve blocks (ISB) are commonly used for perioperative pain control after shoulder arthroscopy. Bupivacaine has historically been the primary anesthetic used in ISBs. In 2018, the U.S. Food and Drug Administration approved liposomal bupivacaine for ISBs. This study aims to identify the effect of ISBs using bupivacaine alone (B) versus liposomal bupivacaine + bupivacaine (LBB) on postoperative pain control after arthroscopic rotator cuff repair (RCR). A single-center, prospective, double-blinded, randomized, control trial following Consolidated Standards of Reporting guidelines was conducted from January 2020 to April 2024; 128 opiate naive patients undergoing arthroscopic RCR were randomized 1:1 into the B-only group (25 cc of 0.5% bupivacaine) versus the LBB group (133 mg [10 mL] of liposomal bupivacaine + 15 cc 0.5% bupivacaine). Demographics, comorbidities, additional procedures performed, daily morphine milligram equivalents (MME) consumed, and daily visual analog scale (VAS) pain scores for 14 days were collected. No differences were noted between age, sex, comorbidities, or American Society of Anesthesiologists physical classification system scores. On postoperative day 2, the LBB group consumed markedly lower MMEs (0.0 [0.0 to 7.5] versus 0.0 [0.0 to 15.0]; [P = 0.04]) and demonstrated a notable improvement in VAS scores on postoperative day 2 (4.8 ± 3.0 versus 6.0 ± 2.8; [P = 0.03]). No notable difference was seen in other daily MMEs consumed, daily VAS scores, or total 14-day MMEs. Total median MME consumed in both groups was low (MME 35.6 [7.5 to 88.1] or 5 [1 to 12] oxycodone pills). Although the use of LBB in ISBs led to markedly lower VAS scores and less narcotic consumption on postoperative day (POD2), these findings can be regarded as not clinically notable. The difference was the equivalent of one oxycodone tablet, and VAS did not meet minimal clinically important difference. No other differences were found in MME consumed or VAS scores during the first 2 weeks postoperatively following RCR. Overall narcotic consumption was low in both groups. I.