Journal Article

Brachial Plexus Block with Liposomal Bupivacaine for Shoulder Surgery Improves Analgesia and Reduces Opioid Consumption: Results from a Multicenter, Randomized, Double-Blind, Controlled Trial

Patel, Manish A, Bao, Xiaodong, Gadsden, Jeffrey C, Bendtsen, Thomas F, Zeballos, Jose L, Ayad, Sabry S, Nedeljkovic, Srdjan S, Yu, Vincent

2020

Overview

Abstract Objective The utility of single-injection and continuous peripheral nerve blocks is limited by short duration of analgesia and catheter-related complications, respectively. This double-blind, multicenter trial evaluated the efficacy, safety, and pharmacokinetics of single-injection, ultrasound-guided brachial plexus block (BPB) with liposomal bupivacaine (LB) added to a standardized pain management protocol for shoulder surgery. Methods Adults undergoing total shoulder arthroplasty or rotator cuff repair were randomized to receive LB 133 mg, LB 266 mg (pharmacokinetic and safety analyses only), or placebo, added to a standardized analgesia protocol. The primary end point was area under the curve (AUC) of visual analog scale pain intensity scores through 48 hours postsurgery. Secondary end points were total opioid consumption, percentage of opioid-free patients, and time to first opioid rescue through 48 hours. Pharmacokinetic samples were collected through 120 hours and on days 7 and 10. Adverse events were documented. Results One hundred fifty-five patients received treatment (LB 133 mg, N = 69; LB 266 mg, N = 15; placebo, N = 71). BPB with LB 133 mg was associated with significantly improved AUC of pain scores (least squares mean [SE] = 136.4 [12.09] vs 254.1 [11.77], P < 0.0001), opioid consumption (least squares mean [SE] = 12.0 [2.27] vs 54.3 [10.05] mg, P < 0.0001), median time to opioid rescue (4.2 vs 0.6 h, P < 0.0001), and percentage of opioid-free patients (treatment difference = 0.166, 95% confidence interval = 0.032–0.200, P = 0.008) through 48 hours vs placebo. Adverse event incidence was comparable between groups. Conclusions Single-injection BPB with LB 133 mg provided analgesia through 48 hours postsurgery with reduced opioid use compared with placebo after shoulder surgery.

• Publisher: Oxford University Press
• Subject: Aged / Analgesia / Analgesia - methods / Analgesics, Opioid - therapeutic use / Anesthetics, Local - administration & dosage / Brachial plexus / Brachial Plexus Block - methods / Bupivacaine / Bupivacaine - administration & dosage / Care and treatment / Complications and side effects / Dosage and administration / Double-Blind Method / Double-blind studies / Drug therapy / Female / Humans / Injection / Local anesthesia / Male / Methods / Middle Aged / Narcotics / Nerve block / Opioids / Orthopedic Procedures - adverse effects / Pain / Pain management / Pain Management - methods / Pain perception / Pain, Postoperative / Pain, Postoperative - etiology / Pain, Postoperative - prevention & control / Patients / Peripheral nerves / Pharmacokinetics / Shoulder / Shoulder - surgery / Surgery / Ultrasound