Liposomal bupivacaine, dexamethasone reduced postoperative pain after shoulder arthroplasty
Patients undergoing shoulder arthroplasty who received a standardized multimodal pain management as well as intraoperative liposomal bupivacaine and intravenous dexamethasone had a significant reduction in length of stay, overall narcotic use and VAS pain scores, according to results.
Howard D. Routman, DO, and his colleagues divided 55 patients undergoing shoulder arthroplasty into two groups, both of which received perioperative multimodal management with preoperative and postoperative intravenous (IV) and oral narcotics, gabapentin, nonsteroidal anti-inflammatory drugs, acetaminophen and single-injection interscalene block. After the skin incision and liposomal bupivacaine injected at surgery, patients in cohort 2 received 8 mg to 10 mg of IV dexamethasone, according to researchers. Researchers analyzed patients who did and did not use preoperative narcotics together and separately, and evaluated hospital length of stay, narcotic use and VAS pain before and after the change in perioperative protocol.
Compared with cohort 1, results showed significantly less pain at postoperative day 0 and day 1 and significantly lower doses of opioids at postoperative day 1 and cumulatively for postoperative days 0 and 1 in cohort 2. Researchers also found a significantly shorter hospital length of stay among cohort 2. Patients in cohort 2 using preoperative narcotics reported less pain on postoperative day 1, less cumulative narcotic use and short hospitalization vs. patients in cohort 1, according to results. – by Casey Tingle
Disclosures: Routman is a consultant for Pacira Pharmaceuticals. Please see the full study for a list of all other authors’ relevant financial disclosures.