Hunter Firment , 2025-04-16 18:14:00
April 16, 2025
2 min read
Key takeaways:
- Use of interscalene block during total shoulder arthroplasty had similar pain scores to interscalene catheters.
- Secondary outcomes were also similar among the groups.
SAN DIEGO — Results showed interscalene blocks with liposomal bupivacaine and single-injection interscalene blocks with dexamethasone may yield similar analgesic outcomes to interscalene catheters with bupivacaine in shoulder arthroplasty.
“[These results] can empower someone to choose or utilize their anesthetic of choice based on what their anesthesiologist is recommending, what they feel comfortable with or what they have had good experience with,” Paul J. Cagle Jr., MD, professor of orthopedic surgery in the division of shoulder and elbow surgery at the Icahn School of Medicine at Mount Sinai, told Healio about results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
In the study — simultaneously published in Journal of Shoulder and Elbow Surgery — Cagle and colleagues randomly assigned 72 patients undergoing elective primary total shoulder arthroplasty to receive either an interscalene block with liposomal bupivacaine (n = 24), a single-injection interscalene block with a dexamethasone adjuvant (n = 24) or an interscalene catheter with bupivacaine (n = 24).
The primary outcome in the study was numeric rating scale (NRS) pain scores. Secondary outcomes included first analgesic request, intraoperative opioid consumption, opioid consumption in the recovery room, total inpatient opioid consumption, time of analgesia duration, time of motor recovery, arm numbness, hand strength/motor grip, motor block, post-anesthesia care unit length of stay and hospital length of stay, according to the study.
Overall, Cagle said the three groups had no statistical differences in the primary or secondary outcome measures.
“Interestingly, the primary outcome had no difference. If we looked at each time point sequentially … there was no difference between the groups or the rating of their pain scale,” Cagle said in his presentation. “Surprisingly as well, there were no secondary differences. When we looked at intraoperative use, postoperative use of opioids, time to motor recovery, duration of anesthesia, sensation, hand strength, [and Patient-Reported Outcomes Measurement Information System], none of these had a significant difference when we compared all the groups.”
References:
- Cagle PJ Jr., et al. Comparison of analgesic efficacy of continuous perineural catheter, liposomal bupivacaine, and dexamethasone as an adjuvant for interscalene block in total shoulder arthroplasty: a triple-blinded randomized controlled trial. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
- Pai BHP, et al. J Shoulder Elbow Surg. 2025;doi:10.1016/j.jse.2024.06.014.
For more information:
Paul J. Cagle Jr., MD, can be reached at paul.cagle@mountsinai.org.
Sources/Disclosures
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Cagle PJ Jr., et al. Comparison of analgesic efficacy of continuous perineural catheter, liposomal bupivacaine, and dexamethasone as an adjuvant for interscalene block in total shoulder arthroplasty: a triple-blinded randomized controlled trial. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
Disclosures:
Cagle reports consulting for Arthrex, Exactech and Stryker. Please see the study for all other authors’ relevant financial disclosures.