Reduced Opioid Use Among Patients Who Received Liposomal Bupivacaine Brachial Plexus Block for Total Shoulder Arthroplasty.

Purpose This retrospective cohort explores the efficacy of regional shoulder blocks using Exparel™ in patients undergoing total shoulder arthroplasty (TSA)/reverse total shoulder arthroplasty (RSA) to reduce total opioid prescription, refills, and length of stay in the acute care setting. Methods Patients who underwent TSA/RSA by a single surgeon in a three-year period were evaluated. Patients in the case group received liposomal bupivacaine 1.3% brachial plexus block while the control group received ropivacaine 0.5% interscalene brachial plexus block. Outcomes of the study included the number of opioids taken, opioids prescribed, and length of hospital stay. Results Thirty-six patients underwent TSA/RSA between January 2017 and March 2020. Patients who received an Exparel brachial plexus block had decreased opioid use within the first 24 hours after surgery compared to the ropivacaine group, 9.00 ± 14.10 and 26.20 ± 24.8 morphine milligram equivalent (MME), respectively (p=0.0213). Patients who received an Exparel brachial plexus block had decreased opioid prescriptions over the entire postoperative follow-up, 411.00 ± 200.74 MME in the case group and 593.07 ± 297.57 MME in the control group (p=0.0314). Lastly, patients who received an Exparel brachial plexus block had a shorter length of hospital stay, 1.28 ± 0.91 days as compared to the control group's 2.15 ± 1.49 days (p=0.0451). Conclusion This study demonstrates a significant reduction in opioid prescribing and use in patients who receive Exparel brachial plexus nerve blocks compared to non-liposomal local anesthetics, as well as a significant reduction in the length of hospital stay. The data suggest that Exparel use may decrease the risks associated with opioid use while providing adequate analgesia in patients undergoing shoulder arthroplasty.

Postoperative Rehabilitation of Posterior Glenohumeral Joint Instability Surgery: A Systematic Review.

Posterior glenohumeral (GH) joint instability is uncommon compared with anterior and multidirectional instability. A variety of surgical techniques are used to treat posterior GH instability. As a result, there are numerous rehabilitation protocols that vary greatly. The objective of this review was to define, evaluate and compare the postsurgical rehabilitation protocols for patients treated surgically for posterior GH instability. The review contains articles that outline a rehabilitation protocol following a surgical repair of posterior GH instability. A multidatabase search was conducted. Two independent, blinded reviewers decided on inclusion and exclusion of each study, with a second round to resolve conflicts. Data was extracted from the pertinent studies after the grading of evidence was conducted by 2 reviewers. Sixteen studies of the original 859 were included. Most studies included a 3-phase to 4-phase protocol that consisted of immobilization, remobilization, strength training, and sport-specific training. A review of current literature shows a paucity of high-quality studies regarding outcomes of rehabilitation following surgery for posterior GH instability. Most studies had favorable results, with most patients returning to their presurgical level of activity.

Reduced Opioid Use Among Patients Who Received Liposomal Bupivacaine for ACL Reconstruction.

Standard multimodal pain management for anterior cruciate ligament reconstruction typically includes a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and opioids. Opioids present a substantial risk, and there is a rising number of prescription opioid-related overdoses in the United States. The goal of this study was to evaluate the quantity of opioids prescribed to patients who received liposomal bupivacaine as a component of their multi-modal pain regimen. The electronic medical records of patients who underwent anterior cruciate ligament reconstruction by a single surgeon at an urban hospital during a 2-year period were evaluated. Patients in the case group received liposomal bupivacaine and those in the control group did not. Statistical analysis of the number of pills prescribed and numeric pain rating scale scores was performed with a 2-tailed unequal variance t test. Statistical analysis of opioid prescription refills was performed with a chi-square test. A total of 67 patients were included. The mean number of 5-mg oxycodone tablets prescribed to the case group (9.29±10.29 tablets) was significantly lower (P<.01) compared with the number prescribed to the control group (66.26±37.13 tablets). Patients in the case group also were less likely to require an opioid prescription refill at the first follow-up appointment (P<.01; absolute risk reduction, 50%; number needed to treat, 2). Mean numeric pain rating scale score at 2 weeks was 2.8±2.1 in the case group and 3.8±2.4 in the control group (P=.09). Patients who received liposomal bupivacaine as part of multimodal pain management had significantly fewer opioid prescriptions. Despite the reduction in opioids prescribed, patients in the case group only showed a trend toward a reduction in pain at 2-week follow-up. [Orthopedics. 2021;44(2):e229-e235.].