Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty A meta-analysis of randomized control trails

Background: This meta-analysis aimed to compare the efficiency and safety of liposomal bupivacaine infiltration and interscalene nerve block for pain control after total shoulder arthroplasty. Methods: A systematic search was performed in Medline (1966 to May 2017), PubMed (1966 to May 2017), Embase (1980 to May 2017), ScienceDirect (1985 to May 2017) and the Cochrane Library. Only randomized controlled trials (RCTs) were included. Reported surgical outcomes, including visual analogue scale (VAS) scores, opioid consumption, length of stay, and postoperative adverse effects including the risk of nausea and vomiting. Meta-analysis was performed using Stata 11.0 software. Results: Four RCTs including 510 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of VAS score at 12hours (standard mean difference [SMD]=0.272, 95% CI: -0.150 to 0.695, P=.207), 24hours (SMD=-0.056, 95% CI: -0.458 to 0.346, P=0.785), and 48 hours (SMD=0.183, 95% CI: -0.148 to 0.513, P=.278). Liposomal bupivacaine infiltration groups required an equivalent amount of opioids at postoperative 12hours (SMD=-0.039, 95% CI: -0.222 to 0.143, P=.672), 24hours (SMD=0.046, 95% CI: -0.136 to 0.228, P=.618) and 48 hours (SMD=-0.025, 95% CI: -0.207 to 0.157, P=.785). Conclusion: Liposomal bupivacaine infiltration provides equivalent postoperative pain control compared with interscalene nerve block following total shoulder arthroplasty. Both of them can reduce the consumption of opioids without severe adverse effects. More high-quality RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of liposomal bupivacaine infiltration with interscalene nerve block.