Background/Objectives: Interscalene brachial plexus block (ISB) is a common regional anesthesia technique for analgesia in patients undergoing shoulder surgery. Liposomal bupivacaine (LB) was developed to prolong analgesia duration; however, the existing literature demonstrates mixed results regarding its efficacy. This study aimed to compare the analgesic effectiveness of near-equipotent doses of LB and plain bupivacaine (PB) for patients undergoing total shoulder arthroplasty (TSA). Methods: This prospective double-blinded randomized controlled trial enrolled 78 elective TSA patients. Participants were randomized to receive an ISB with either 36 mL of 0.5% PB (180 mg) or a mixture of 10 mL of LB, 20 mL of 0.25% PB, and 6 mL of saline (183 mg). The primary outcome was the proportion of patients with clinically tolerable pain scores (visual analog scale (VAS) ≤ 4) on postoperative day (POD) 1 in each group. Secondary outcomes included the proportion of patients with clinically tolerable pain scores on POD 2–5, overall pain scores in the post-anesthesia care unit (PACU) and on POD 1–5, Quality of Recovery Survey-15 (QoR-15) scores on POD 1–5, analgesic consumption on the day of surgery and on POD 1–5, and adverse events. Results: A total of 67 patients completed the study. There was a statistically significant increase in median body mass index (BMI) in the PB vs. LB group (30.0 (27.4–33.1) vs. 27.0 (24.3–29.4), p = 0.0197). All other demographic characteristics were comparable between groups. There was no difference in the primary outcome or any of the secondary outcomes. Conclusions: LB did not reduce postoperative pain compared to PB. Larger, multicenter studies are warranted to further evaluate the clinical benefit of LB in this population.
Lee et al. (Thu,) studied this question.