Postoperative Pain Control in Total Shoulder Arthroplasty

Phase 4

Completed

• Conditions: Total Shoulder Arthroplasty
• Interventions: Drug: Liposomal bupivacaine; Drug: Bupivacaine

• Registration Number: NCT05068960
• Lead Sponsor: Scripps Clinic

Brief Summary

A double blind, prospective, randomized trial to evaluate postoperative pain, narcotic use, patient satisfaction, and function among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine.

Detailed Description

In order to reduce narcotic abuse potential, orthopaedic surgeons have explored multimodal pain regimens in addition to regional anesthesia to improve postoperative pain control. One commonly used intervention to reduce postoperative shoulder pain has been the interscalene brachial plexus block. This block provides significant pain relief for shoulder procedures, but has been limited to less than 24 hours even with long acting anesthetics. In the setting of shoulder arthroplasty, this short-term pain control often leads to the need for increased narcotic pain medication. Since shoulder arthroplasty has been steadily increasing in the United States with an annual growth rate of 10.6%, it is imperative to control patients' postoperative pain without increasing their risk for opiate abuse. A potential method for achieving this is by using liposomal bupivacaine in the interscalene blocks.

This study is a double blind, prospective, randomized trial to evaluate the postoperative pain profiles among shoulder arthroplasty patients receiving interscalene block with and without the addition of liposomal bupivacaine. The purpose of this study is to determine if patients undergoing shoulder arthroplasty with an interscalene brachial plexus block with liposomal bupivacaine (study group) or without liposomal bupivacaine (control group) will have differences in postoperative opiate consumption, patient-reported pain, satisfaction with surgery, and shoulder function.

Study Timeline

• Study Start: 2021-03-01
• Study First Submitted: 2021-07-21
• Study First Submitted QC: 2021-09-30
• Study First Posted: 2021-10-06
• Primary Completion: 2025-02-01
• Study Completion: 2025-02-01
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-18
• Last Update Posted: 2025-03-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Patients undergoing primary shoulder arthroplasty or reverse shoulder arthroplasty

Exclusion Criteria

• Patients under the age of 50 years
• Patients over the age of 85
• Patients undergoing a revision shoulder procedure
• Documented drug or alcohol abuse
• Active narcotic use within 3 months prior to surgery
• Neurological deficit
• Allergy to amide anesthetics
• Oxycodone intolerance
• Unable to take Celebrex
• Enrollment in another clinical trial
• Comorbidity that is contraindicated with the administration of an interscalene block
• Cognitive or mental health status that interferes with study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Study group	Bupivacaine	The study group will receive an interscalene block consisting of 10 mL 0.5% bupivacaine and 10 mL of liposomal bupivacaine \[133mg\].
Control group	Bupivacaine	The control group will receive an interscalene block consisting of 20 mL of 0.5%bupivacaine alone.
Study group	Liposomal bupivacaine	The study group will receive an interscalene block consisting of 10 mL 0.5% bupivacaine and 10 mL of liposomal bupivacaine \[133mg\].

Primary Outcome Measures

Name	Time	Method
Narcotic usage	Postoperatively (up to 1 week)	Number and type of narcotic pain pills consumed during the first postoperative week (also converted into morphine equivalents)

Secondary Outcome Measures

Name	Time	Method
Severity of pain and its impact on functioning (Brief Pain Inventory - Short Form modified)	Postoperatively (at 1 week)	Patients' self-reported pain severity and impact on functioning as measured on the Brief Pain Inventory Short-Form modified survey
Pain score (Numeric Rating Scale): Preoperatively, postoperatively, and change from preoperatively to postoperatively	Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively	Patients' self-reported pain as measured on the Numeric Rating Scale
Satisfaction with the results of surgery (Self-Administered Patient Satisfaction Scale)	Postoperatively (at 4 weeks)	Patients' satisfaction with results of surgery as measured on the Self-Administered Patient Satisfaction Scale
American Shoulder and Elbow Surgeons (ASES) score: preoperatively, postoperatively, and change from preoperatively to postoperatively	Preoperatively (up to 30 days before surgery) and postoperatively (at 4 weeks), and change from preoperatively to postoperatively	The ASES score is a 100-point scale that evaluates two dimensions of shoulder function: pain and performance in activities of daily living. Each of the two domains make up for 50 of the 100 points. A score of 0 indicates the worst shoulder condition and a score of 100 indicates the best shoulder condition.
Non narcotic pain medication usage	Postoperatively (up to 1 week)	Number and type of non-narcotic pain pills consumed during the first postoperative week

Trial Locations

Locations (1)

Scripps Clinic; 🇺🇸 La Jolla, California, United States