Liposomal bupivacaine mixture has similar pain relief and significantly fewer complications at less cost compared with indwelling interscalene catheter in total elbow arthroplasty

Kirk M. Thompson, Richard Smith, Tyler J. Brolin, Frederick M. Azar, Thomas W. Throckmorton

Research output: Contribution to journalArticle

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Abstract

Background: Postoperative pain control, short-term and long-term narcotic consumption, complication rates, and costs of indwelling interscalene catheter (ISC) were compared with a liposomal bupivacaine (LBC) mixture in patients undergoing primary total elbow arthroplasty. Methods: Forty-four consecutive patients were identified, the first 28 with an ISC and the later 16 with intraoperative LBC injection that also included ketorolac and 0.5% bupivacaine. Medical records were reviewed for visual analog scale scores for pain, oral morphine equivalent (OME) use, complications, and facility charges. Results: Average visual analog scale scores at 24 hours, 2 weeks, 6 weeks, and 12 weeks were not significantly different. Mean OME use was significantly greater in the LBC group at 24 hours but less at 12 weeks, although this difference was not statistically significant. Twelve anesthetic-related complications occurred in the ISC group (1 major and 11 minor); 10 patients (36%) had at least 1 complication. The major complication was respiratory failure requiring emergent tracheostomy. Minor complications included leaking pump/catheters, catheters inadvertently pulled out early, global hand paresthesias, forearm paresthesias, and pain at the catheter site. There were no anesthetic-related complications in the LBC group. The average charge for the LBC mixture was $327.10; charges for ISC, including equipment and anesthesia fees, were $1472.42. Conclusions: An LBC mixture provides similar pain relief with fewer complications at a lower cost than indwelling ISC after total elbow arthroplasty. Although the OME use in the LBC group was almost double that of the ISC group at 24 hours, there was no difference at later time points.

Original languageEnglish (US)
Pages (from-to)2257-2261
Number of pages5
JournalJournal of Shoulder and Elbow Surgery
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2018

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Indwelling Catheters
Bupivacaine
Elbow
Arthroplasty
Catheters
Costs and Cost Analysis
Pain
Morphine
Paresthesia
Anesthetics
Ketorolac
Fees and Charges
Tracheostomy
Narcotics
Pain Measurement
Postoperative Pain
Visual Analog Scale
Forearm
Respiratory Insufficiency
Medical Records

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

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Liposomal bupivacaine mixture has similar pain relief and significantly fewer complications at less cost compared with indwelling interscalene catheter in total elbow arthroplasty. / Thompson, Kirk M.; Smith, Richard; Brolin, Tyler J.; Azar, Frederick M.; Throckmorton, Thomas W.

In: Journal of Shoulder and Elbow Surgery, Vol. 27, No. 12, 01.12.2018, p. 2257-2261.

Research output: Contribution to journalArticle

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