Local infiltration, interscalene block yield similar analgesia after shoulder arthroplasty
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Despite higher pain scores at 8 hours postoperatively and increased opioid use, local infiltration analgesia was less costly and yielded similar pain scores at 24 hours after shoulder arthroplasty compared with an interscalene block.
In a level-1, prospective randomized trial, Michael Ewing, MD, and colleagues from the University of Missouri compared outcomes between 37 patients who underwent primary shoulder arthroplasty with a local infiltration analgesia (LIA) injection, which included ropivacaine, epinephrine and ketorolac, and 37 patients who received an interscalene block with liposomal bupivacaine.
According to the study, outcome measures included VAS pain scores, opioid consumption in morphine milligram equivalents (MMEs) and complications. Mean pain scores during the first 24 hours postoperatively were used to determine noninferiority between the groups.
Ewing and colleagues found no statistically significant differences between mean pain scores at any time point expect for 8 hours postoperatively, when the LIA group had a mean score of 3.7 and the block group had a mean score of 2.2. Overall, noninferiority testing determined the LIA group to be noninferior to the block group in terms of mean pain scores.
Researchers also found no differences in postoperative opioid consumption between the groups, as total MMEs from postoperative day 1 to postoperative day 7 was 92.8 MMEs in the LIA group and 93.5 MMEs in the block group. However, Ewing and colleagues noted the amount of intraoperative opioid consumption was significantly higher in the LIA group (14.1 MMEs) compared with the block group (6.6 MMEs).
Mean hospital charge was $157 for LIA and $1,718 for an interscalene block, according to the study. One patient in the block group developed transient phrenic nerve palsy, while one patient in the LIA group developed dislocation after reverse arthroplasty related to noncompliance, the researchers added.
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