The safety and efficacy of liposomal Bupivacaine administration in patients undergoing shoulder arthroplasty: An integrative review

Abstract

The aim of this integrative review is to examine and report current evidence regarding the safety and efficacy of liposomal bupivacaine (LB) administration for post-operative analgesia in shoulder arthroplasty. The two administration methods examined are peri-neural and peri-articular infiltration. Articles published between 2008 and 2018 were critically appraised for validity, reliability, and rigor of study. The safety profile of subcutaneous and peri-neural administration of LB has been well documented by research. Risks of myotoxicity and neurotoxicity from LB administration are similar compared to Bupivacaine HCL when used at lower dosages (2.5-3 mg/kg). Evidence from animal studies show that peri-articular infiltration of LB introduces less risk of chondrocyte death compared to Bupivacaine HCL. Peri-articular infiltration of LB is most efficacious when combined with a single shot interscalene nerve block (ISNB) containing Bupivacaine or Ropivacaine HCL. If ISNB is contraindicated, peri-articular infiltration of LB should be combined with Bupivacaine HCL to provide earlier onset local anesthesia. More research is needed to determine which method of LB administration is more effective in reducing post-operative pain scores and narcotic usage; intra-articular infiltration or interscalene nerve blockade. The current published research does not provide enough evidence to suggest that administration of LB via single shot ISNB provides better pain relief compared to peri-articular infiltration. If ISNB is preferred, it is suggested LB be co-administered with Bupivacaine HCL. More research is needed to determine which method of LB administration is more efficacious; peri-articular infiltration or interscalene nerve blockade.