Efficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis

• Published in: Journal of shoulder and elbow surgery 2019-09, Vol.28 (9), p.1824-1834
• Main Authors: Kolade, Oluwadamilola, Patel, Karan, Ihejirika, Rivka, Press, Daniel, Friedlander, Scott, Roberts, Timothy, Rokito, Andrew S., Virk, Mandeep S.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Anesthesia, Local - methods; Anesthetics, Local - administration & dosage; Arthroplasty, Replacement, Shoulder - adverse effects; Arthroscopy - adverse effects; Brachial Plexus Block; Bupivacaine - administration & dosage; Humans; interscalene nerve block; Length of Stay; Liposomal bupivacaine; Liposomes; nonliposomal local anesthetics; opioids; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; reverse shoulder arthroplasty; Rotator Cuff Injuries - surgery; rotator cuff repair; Shoulder - surgery; shoulder arthritis; total shoulder arthroplasty
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.04.054

The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. A systematic literature review of randomized controlled clinical studies comparing the efficacy of LB with NLAs in shoulder surgery was conducted. Seven level I and II studies were included in the meta-analysis, and shoulder surgical procedures included arthroscopic rotator cuff repair and shoulder arthroplasty. Bias was assessed using The Cochrane Collaboration's tool. The primary outcome measures were visual analog scale pain scores and opioid consumption 24 and 48 hours after shoulder surgery. Subgroup analysis was performed for the method of LB administration (interscalene nerve block vs. local infiltration). A total of 7 studies (535 patients) were included in the final meta-analysis comparing LB (n = 260) with NLAs (n = 275). No significant difference was found between the LB and NLA groups in terms of visual analog scale pain scores at 24 hours (95% confidence interval, –1.02 to 0.84; P = .86) and 48 hours (95% confidence interval, –0.53 to 0.71; P = .78). Both groups had comparable opioid consumption at both 24 hours (P = .43) and 48 hours (P = .78) postoperatively and with respect to length of stay (P = .87) and adverse events (P = .97). Subgroup analysis demonstrated comparable efficacy irrespective of the method of administration of LB. LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.