Background: 

Liposomal bupivacaine (LB) theoretically is longer-acting compared with conventional bupivacaine. The purpose of this study was to compare conventional bupivacaine combined with dexamethasone (control group), LB combined with conventional bupivacaine (LB group), and LB combined with dexamethasone and conventional bupivacaine (LBD group) in a perineural interscalene nerve block during ambulatory arthroscopic rotator cuff repair to determine if LB decreased postoperative narcotic consumption and pain. The effect of supplemental dexamethasone on prolonging the analgesic effect of LB was also assessed.

Methods: 

This was a prospective, double-blinded, randomized controlled trial of 76 consecutive patients who underwent outpatient arthroscopic rotator cuff repair. Patients were randomized into the 3 interscalene-block treatment groups: control group (n = 26), LB group (n = 24), and LBD group (n = 26). Outcome measures included pain measured with a visual analog scale (VAS; 0 to 10) and narcotic consumption measured in oral morphine milligram equivalents (MME). Both were measured daily on postoperative day 0 through postoperative day 4.

Results: 

Generalized estimating equation modeling revealed that narcotic consumption across all time points (postoperative days 0 to 4) was significantly lower in the LB group compared with the control group (mean difference, −8.5 MME; 95% confidence interval, −15.4 to −1.6; p = 0.015). Narcotic consumption was significantly higher in the control group on postoperative days 2 and 3 compared with the LB group (p = 0.004 and p = 0.02, respectively) and the LBD group (p = 0.01 and p = 0.003, respectively). There was no difference in narcotic consumption between the LBD and LB groups on any postoperative day. VAS pain scores in all groups were similar across all postoperative days.

Conclusions: 

Among patients undergoing outpatient arthroscopic rotator cuff repair, the addition of LB to conventional bupivacaine in interscalene nerve blocks appeared to be effective in controlling postoperative pain. Because LB with and without dexamethasone decreased postoperative narcotic use, LB should be considered for use in preoperative interscalene nerve blocks to reduce the reliance on narcotics for pain management.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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单发脂质体布比卡因减少门诊肩袖修复术后的麻醉剂使用：一项前瞻性，双盲，随机对照试验

背景： 

理论上，与常规布比卡因相比，脂质体布比卡因（LB）作用更长。这项研究的目的是比较动态关节镜旋转时在神经外斜肌间神经阻滞中常规布比卡因联合地塞米松（对照组），LB联合常规布比卡因（LB组）和LB联合地塞米松和常规布比卡因（LBD组）的作用。进行袖套修复以确定LB是否减少术后麻醉药的消耗和疼痛。还评估了地塞米松补充剂对延长LB镇痛作用的作用。

方法： 

这是一项前瞻性，双盲，随机对照试验，共纳入76位连续的患者，这些患者均接受了门诊关节镜旋转套修复。将患者随机分为3个肌间沟阻断治疗组：对照组（n = 26），LB组（n = 24）和LBD组（n = 26）。结果测量包括使用视觉模拟量表（VAS； 0至10）测量的疼痛和以口服吗啡毫克当量（MME）测量的麻醉消耗。两者均在术后第0天至术后第4天每天进行测量。

结果： 

广义估计方程模型显示，与对照组相比，LB组在所有时间点（术后0至4天）的麻醉剂消耗量均显着降低（均值差，-8.5 MME； 95％置信区间，-15.4到-1.6；均值，-1.5。 p = 0.015）。与LB组（分别为p = 0.004和p = 0.02）和LBD组（分别为p = 0.01和p = 0.003）相比，对照组在术后第2天和第3天的麻醉剂消耗量显着更高。术后任何一天，LBD组和LB组之间的麻醉剂消耗量均无差异。在所有术后天中，所有组的VAS疼痛评分均相似。

结论： 

在接受门诊关节镜肩袖修补术的患者中，向斜肌间神经阻滞的常规布比卡因中添加LB似乎对控制术后疼痛有效。由于有或没有地塞米松的LB减少了术后麻醉剂的使用，因此应考虑将LB用于术前斜纹肌间神经阻滞，以减少对麻醉剂的疼痛控制。

证据级别： 

治疗I级。有关证据水平的完整说明，请参见《作者说明》。