Liposomal Bupivacaine in Managing Postoperative Pain Following Shoulder Surgery

Abstract

To optimize postoperative analgesia following shoulder surgery, current literature recommends multimodal approaches, including the use of regional liposomal bupivacaine (LB), a long-acting local anesthetic. The liposomal formulation of bupivacaine affords it a longer duration of action without a substantial peak plasma concentration; this combined with 3% free bupivacaine provides patients with substantial, prolonged postoperative analgesia following shoulder surgery. The use of LB as part of a multimodal approach to postoperative pain results in diminished use of opioids, reduced pain, and decreased length of hospitalization. Current literature supports these effects following a wide variety of shoulder procedures; however, some studies describe no benefit and list drawbacks including higher costs when electing to use LB instead of comparable, more affordable treatment modalities. In the interest of reducing the number of opioid prescriptions following orthopedic procedures, it is imperative to continue investigating the efficacy of LB as an opioid-sparing pain reducer. Recent literature suggests certain patient populations may be less suitable for implementing this treatment modality; namely those with a history of opioid use, prior surgeries, substantial systemic illness, and existing cardiopulmonary compromise. Patient demographics may be an additional consideration when determining the potential utility of LB to optimize analgesia after shoulder surgery.