A double blind, prospective, randomized trial to evaluate postoperative pain, narcotic use, patient satisfaction, and function among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine.
In order to reduce narcotic abuse potential, orthopaedic surgeons have explored multimodal pain regimens in addition to regional anesthesia to improve postoperative pain control. One commonly used intervention to reduce postoperative shoulder pain has been the interscalene brachial plexus block. This block provides significant pain relief for shoulder procedures, but has been limited to less than 24 hours even with long acting anesthetics. In the setting of shoulder arthroplasty, this short-term pain control often leads to the need for increased narcotic pain medication. Since shoulder arthroplasty has been steadily increasing in the United States with an annual growth rate of 10.6%, it is imperative to control patients' postoperative pain without increasing their risk for opiate abuse. A potential method for achieving this is by using liposomal bupivacaine in the interscalene blocks. This study is a double blind, prospective, randomized trial to evaluate the postoperative pain profiles among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine. The purpose of this study is to determine if patients undergoing shoulder arthroplasty with an interscalene brachial plexus block with liposomal bupivacaine (study group) or without liposomal bupivacaine (control group) will have differences in postoperative opiate consumption, patient-reported pain, satisfaction with surgery, and shoulder function.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
100
Addition of liposomal bupivacaine to the interscalene block for extended pain control following total shoulder arthroplasty
Interscalene block with bupivacaine for pain control following total shoulder arthroplasty
Scripps Clinic
La Jolla, California, United States
Narcotic usage
Number and type of narcotic pain pills consumed during the first postoperative week (also converted into morphine equivalents)
Time frame: Postoperatively (up to 1 week)
Severity of pain and its impact on functioning (Brief Pain Inventory - Short Form modified)
Patients' self-reported pain severity and impact on functioning as measured on the Brief Pain Inventory Short-Form modified survey
Time frame: Postoperatively (at 1 week)
Pain score (Numeric Rating Scale): Preoperatively, postoperatively, and change from preoperatively to postoperatively
Patients' self-reported pain as measured on the Numeric Rating Scale
Time frame: Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively
American Shoulder and Elbow Surgeons (ASES) score: preoperatively, postoperatively, and change from preoperatively to postoperatively
The ASES score is a 100-point scale that evaluates two dimensions of shoulder function: pain and performance in activities of daily living. Each of the two domains make up for 50 of the 100 points. A score of 0 indicates the worst shoulder condition and a score of 100 indicates the best shoulder condition.
Time frame: Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively
Satisfaction with the results of surgery (Self-Administered Patient Satisfaction Scale)
Patients' satisfaction with results of surgery as measured on the Self-Administered Patient Satisfaction Scale
Time frame: Postoperatively (at 4 weeks)
Non narcotic pain medication usage
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Number and type of non-narcotic pain pills consumed during the first postoperative week
Time frame: Postoperatively (up to 1 week)