Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty
Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty
复制标题
DOI：
10.1016/j.arth.2017.03.017
复制
发表时间：
2017-11-01
影响因子：
3.5
通讯作者：
Throckmorton, Thomas W.
中科院分区：
文献类型：
--
作者：
Weller, William J.;Azzam, Michael G.;Throckmorton, Thomas W.
背景：在初次肩关节置换术患者中，置入斜角间导管(ISC)和脂质体布比卡因(LBC)的疗效和费用是目前争论的焦点。方法：在214例肩关节置换术中，156例患者使用ISC，58例使用LBC注射，其中混合了吗啡、酮咯酸和0.5%布比卡因与肾上腺素。观察疼痛评分、口服吗啡当量(OME)用量、主要并发症和费用。结果：视觉模拟评分在24小时、2周、6周和12周时无显著差异。LBC组24小时的平均OME摄入量显著高于LBC组，但在12周时差异不显著。ISC患者发生重大并发症的相对风险几乎是LBC患者的4倍。下腔静脉混合液的平均费用为289.04美元，下腔静脉混合液的平均费用为1559.42美元，包括设备和麻醉费。结论术中混合液术中止痛效果相当，主要并发症明显减少，且费用明显低于下腔静脉混合液。在24小时内，LBC需要几乎两倍于OME的OME才能达到相同的疼痛缓解水平，但门诊麻醉剂的累积使用量没有显著差异。(C)2017 Elsevier Inc.保留所有权利。
Background: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate.Methods: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs.Results: Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42.Conclusion: The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use. (C) 2017 Elsevier Inc. All rights reserved.