Interscalene Block With Liposomal Bupivacaine vs. Interscalene Block With Bupivacaine and Adjuvants

Single Injection Interscalene Brachial Plexus Nerve Block With Adjuvants vs. Liposomal Bupivacaine Interscalene Brachial Plexus Nerve Block for Total Shoulder Arthroplasty

The purpose of this study is to determine whether the use of plain bupivacaine with common adjuvants for interscalene block (ISB) provides non-inferior analgesic results compared to the use of liposomal bupivacaine for ISB, in patients undergoing total shoulder arthroplasty.

The primary objective of this clinical study is to evaluate the comparative efficacy of interscalene block (ISB) using plain bupivacaine with adjuvants vs. liposomal bupivacaine on mean postoperative pain levels in patients who have undergone a total shoulder arthroplasty within the first 48 hours. Principal Investigators hypothesize that ISB using plain bupivacaine with adjuvants will provide similar pain relief as ISB using liposomal bupivacaine.

Inclusion Criteria:

• All patients undergoing total shoulder arthroplasty (not a reverse)
• Age ≥ 18 years
• Ability to understand and the willingness to sign an IRB-approved informed consent document.
• ASA patient status I-III patients
• Weight Greater than or equal to 50 kg

Exclusion Criteria:

• Contraindications to an interscalene block or phrenic blockade
• Infection at injection site
• Pre-existing neurological dysfunction affecting the operative extremity
• Chronic pain diagnosis or opioid use >40mg oxycodone daily equivalents or use of long-acting opioids
• BMI >40
• Uncontrolled diabetes (A1c >8.0)
• Concurrent painful physical condition requiring analgesic treatment (eg, NSAID or opioid) in the postsurgical period for pain not strictly related to the surgery
• Contraindications to any pain-control agents planned for surgical or postsurgical use (i.e., bupivacaine, hydromorphone, etc.)
• Patients who are wards of the state
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to bupivacaine or liposomal bupivacaine.
• Patients with moderate-severe hepatic or renal impairment