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  • Comparing liposomal bupivacaine plus bupivacaine to bupivacaine alone in interscalene blocks for rotator cuff repair surgery: a randomized clinical trial

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Original research
Comparing liposomal bupivacaine plus bupivacaine to bupivacaine alone in interscalene blocks for rotator cuff repair surgery: a randomized clinical trial
  1. James M Flaherty1,
  2. Aaron A Berg1,
  3. Alicia Harrison2,
  4. Jon Braman2,
  5. Jonah M Pearson1,
  6. Benjamin Matelich1,
  7. Alexander M Kaizer3 and
  8. Jacob L Hutchins1
  1. 1 Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2 Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3 Biostatistics and Informatics, School of Public Health Department of Biostatistics & Informatics, University of Colorado, Aurora, Colorado, USA
  1. Correspondence to Dr James M Flaherty, Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA; jflahert{at}umn.edu

Abstract

Background Single-injection interscalene brachial plexus blocks are used for analgesia for rotator cuff repair (RCR) but have limited duration. The value of adding liposomal bupivacaine (LB) to prolong single-injection interscalene blocks is unclear. The purpose of this trial is to evaluate the addition of LB to regular bupivacaine interscalene blocks for patients undergoing arthroscopic RCR.

Methods In this prospective, randomized trial, 70 patients undergoing primary RCR with equal group allocation were randomized by random number generator to receive an interscalene block with 20 mL of 0.5% bupivacaine or 10 mL 0.5% bupivacaine plus 133 mg LB. The primary outcome was cumulative opioid consumption within 72 hours of the procedure. Secondary outcomes included maximum pain scores and quality of recovery 15 survey scores.

Results 70 of the 80 randomized patients were included in final analysis following exclusion for protocol violations and loss to follow-up. Cumulative opioid consumption (oral morphine equivalents) within 72 hours in patients receiving LB was a median (IQR) of 31.9 mg (0, 73.1) compared with 45.0 mg (15.0, 108.8) among patients receiving bupivacaine alone (p=0.312). Patients receiving LB demonstrated mixed results regarding worst pain scores with improvements at 24 hours and 72 hours, but not 48 hours.

Conclusions LB added to bupivacaine interscalene blocks does not reduce opioid consumption within 72 hours following arthroscopic RCR.

Trial registration number NCT03587584.

  • brachial plexus
  • ambulatory care
  • nerve block

Data availability statement

Data are available upon reasonable request. Data are available on request to the corresponding author by emailing jflahert@umn.edu.

https://doi.org/10.1136/rapm-2021-103349

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    Data availability statement

    Data are available upon reasonable request. Data are available on request to the corresponding author by emailing jflahert@umn.edu.

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    Footnotes

    • Twitter @aaberg77

    • Contributors JMF: Contributed to study design, data analysis, writing manuscript, editing manuscript, final approval, and serves as guarantor for the submission. AAB: Contributed to study design, writing manuscript, editing manuscript and final approval. AH: Contributed to study design, editing manuscript, and final approval. JB: Contributed to study design, editing manuscript, and final approval. JMP: Contributed to study design, data collection, writing manuscript, editing manuscript, and final approval. BM: Contributed to study design and final approval. AMK: Contributed to study design, data analysis, writing manuscript and editing manuscript. JLH: Contributed to study design, writing manuscript, editing manuscript and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JLH is a speaker, consultant, and has received research funds from Pacira Bioscience, he is a consultant and owns stock with Insitu Biologics, is a consultant and speaker for Acel RX, a consultant for Worrell, received research funds from Avanos, and was a consultant for Johnson and Johnson. AAB is a consultant for Pacira Bioscience.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.