J Shoulder Elbow Surg. 2022 Apr 14
BACKGROUND Total shoulder arthroplasties and rotator-cuff repair surgeries result in considerable postoperative pain. Optimal postoperative pain management based on a multidisciplinary approach are necessary to promote early postoperative rehabilitation. The purpose of this study was to compare liposomal bupivacaine (LB) to traditional, non-liposomal bupivacaine (non-LB) agents following total arthroplasty or rotator cuff repair surgeries.
METHODS Two independent authors searched the PubMed Central, Google Scholar, and Cochrane library websites for suitable articles. We included randomized controlled trials comparing outcomes after LBs and non-LB for rotator cuff repair or total shoulder arthroplasty. The outcome measures for our meta-analysis were VAS pain scores at 24 and 48 hours post-surgery, opioid consumption 24 and 48 hours post-surgery, hospital stay, and complications within 48 hours post-surgery. We used the GRADE tool (Grading of Recommendations Assessment, Development, and Evaluation) to assess the degree of evidence for the outcomes and the Cochrane risk of bias assessment tool to assess the risk of bias.
RESULTS The current meta-analysis comprised 11 randomised controlled studies with 846 subjects. Seven studies used local infiltration to administer LB and three used a block. Our pooled analysis results showed no significant difference in VAS pain scores at 24 hours post-surgery (SMD, -0.27; 95% CI, -0.55 to 0.01; prediction interval, -1.25 to 0.70), VAS pain scores at 48 hours post-surgery (SMD; -0.18, 95% CI, -0.46 to 0.09; prediction interval, -1.10 to 0.73), opioid consumption at 24 hours post-surgery (SMD; 0.04, 95% CI, -0.27 to 0.34; prediction interval, -1.01 to 1.09), and opioid consumption at 48 hours post-surgery (SMD; 0.10, 95% CI, -0.44 to 0.64; prediction interval, -1.76 to 1.96 ) between LB and non-LB group. The LB and non-LB groups had similar hospital stays (SMD, -0.38; 95% CI, -1.51 to 0.74, prediction interval -14.7 to 13.9) and adverse events (RR, 0.89; 95% CI, 0.42 to 1.36) following the shoulder procedures. The level of evidence was low as noted in GRADE analysis.
CONCLUSION Our meta-analysis provides evidence indicating that LB is similar to non-LB in terms of overall pain relief and opioids requirements. The duration of hospital stay and compilation rates were also similar in both groups. Future well-designed and adequately powered randomized controlled studies are needed to confirm our results and be able to recommend LBs for various types of shoulder operations.