Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty

William J. Weller, Michael G. Azzam, Richard Smith, Frederick M. Azar, Thomas W. Throckmorton

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. Methods: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs. Results: Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42. Conclusion: The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use.

Original languageEnglish (US)
Pages (from-to)3557-3562
Number of pages6
JournalJournal of Arthroplasty
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2017

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Indwelling Catheters
Bupivacaine
Arthroplasty
Costs and Cost Analysis
Pain
Morphine
Catheters
Ketorolac
Fees and Charges
Narcotics
Pain Measurement
Visual Analog Scale
Epinephrine
Outpatients
Anesthesia
Equipment and Supplies
Injections

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty. / Weller, William J.; Azzam, Michael G.; Smith, Richard; Azar, Frederick M.; Throckmorton, Thomas W.

In: Journal of Arthroplasty, Vol. 32, No. 11, 01.11.2017, p. 3557-3562.

Research output: Contribution to journalArticle

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