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For analgesia after ambulatory shoulder surgery, bupivacaine with dexamethasone can be utilized interchangeably with liposomal bupivacaine.
According to the findings of a randomized, double-blinded, noninferiority trial, the interscalene nerve blocks using perineural liposomal bupivacaine offered efficacious analgesia comparable to perineural standard bupivacaine along with dexamethasone. Researchers compared the analgesic efficacy of interscalene brachial plexus block with liposomal bupivacaine vs standard bupivacaine with dexamethasone in 112 people undergoing shoulder surgery.
Participants were randomly allocated to: (I) Bupivacaine with dexamethasone group (n = 56): Given admixture of 15 ml of 0.5% standard bupivacaine along with dexamethasone 4 mg, and (II) Liposomal bupivacaine group (n = 55): Given 15-ml premixed admixture of 10 ml of 133 mg liposomal bupivacaine along with 5 ml of 0.5% bupivacaine. The major endpoint ascertained was average numeric rating scale (NRS) pain scores at rest over seventy-two hours.
The mean difference between study groups was investigated against the noninferiority margin of 1.3. The secondary endpoints ascertained were opioid intake, sensory and motor resolution, NRS pain scores at rest and movement on postsurgery days 1 to 4 and again on postsurgery day 7, analgesic block duration occurrence of side effects, participant satisfaction, and readiness for postanesthesia care unit discharge.
The average NRS pain score over 72 hours in the liposomal bupivacaine arm did not show inferiority when compared to bupivacaine plus dexamethasone arm, as shown in Table 1:
No profound difference was noted in the duration of analgesia between the groups. The motor and sensory resolutions were comparable in both groups. No difference was witnessed in adverse events, opioid intake, or readiness for postanesthesia care unit discharge. Regarding interscalene nerve blocks, perineural liposomal bupivacaine offers effective analgesia comparable to perineural standard bupivacaine with dexamethasone.
Anesthesiology
Interscalene Brachial Plexus Block with Liposomal Bupivacaine versus Standard Bupivacaine with Perineural Dexamethasone: A Noninferiority Trial
David H Kim et al.
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