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    ICJR Interviews: Comparing Pain Management Techniques in Shoulder Arthroplasty

    The search continues for the optimal pain management regimen for patients undergoing anatomic and reverse shoulder arthroplasty.

    Interscalene brachial plexus blockade is commonly used for shoulder arthroplasty, but this technique does not allow surgeons to perform early neurologic exams and evaluate patients for complications. Plus, it can result in rebound pain at 8 to 16 hours after surgery.

    A randomized controlled trial from The Rothman Institute in Philadelphia, Pennsylvania, which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando, compared pain scores and opioid consumption in 106 patients who received either an interscalene block (n = 53) or intraoperative injection of liposomal bupivacaine (n=53).

    The researchers said the study results indicate liposomal bupivacaine is a viable alternative to an interscalene block in this patient population, although they believe additional research is needed to determine if it is the optimal solution.

    Rothman surgeon Surena Namdari, MD, said patients who received the interscalene block had better pain control up to the first 8 hours following surgery and lower opioid consumption intraoperatively.

    But pain control was better among patients in the liposomal bupivacaine group at 16 and 24 hours following surgery, Dr. Namdari said. Postoperative opioid consumption was equivalent between groups in the first 24 hours after surgery.

    Click the image above to hear Dr. Namdari’s comments on the study, “Randomized Controlled Trial of Interscalene Block vs. Injectable Liposomal Bupivacaine in Shoulder Arthroplasty” (Paper 089).

    Producer: Susan Doan-Johnson; Director: Michael Bugera; Post Production: Charles J. Maynard