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Local Infiltration Analgesia Versus Interscalene Block for Pain Management Following Shoulder Arthroplasty: A
Michael Ewing1, Haley Huff1, Sally Heil1
1Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.
Summary
Local infiltration analgesia (LIA) and interscalene blocks offer comparable pain relief after shoulder surgery. LIA is less costly but may cause more intraoperative opioid use and slightly higher early pain.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Anesthesiology
Background:
- Interscalene block provides effective shoulder arthroplasty analgesia but carries known risks.
- Local infiltration analgesia (LIA) is used in other joint surgeries, but its shoulder arthroplasty efficacy is less studied.
Purpose of the Study:
- To compare the efficacy of LIA versus interscalene block for pain control and opioid consumption after shoulder arthroplasty.
Main Methods:
- Prospective randomized trial comparing interscalene block (liposomal bupivacaine) with LIA (ropivacaine, epinephrine, ketorolac) in shoulder arthroplasty patients.
- Primary outcome: Noninferiority of LIA to interscalene block for mean pain scores in the first 24 hours postoperatively.
- Secondary outcomes: Postoperative pain scores, opioid consumption, and complications.
Main Results:
- No significant differences in overall pain scores or opioid consumption between LIA and interscalene block groups.
- LIA group experienced significantly higher intraoperative opioid consumption.
- LIA was associated with higher pain scores at 8 hours postoperatively but demonstrated noninferiority for 24-hour pain relief.
- LIA demonstrated substantial cost savings ($157 vs. $1,718 per procedure).
Conclusions:
- LIA and interscalene block offer similar 24-hour analgesia following shoulder arthroplasty.
- LIA is a cost-effective alternative, despite higher intraoperative opioid requirements and a potential for increased early postoperative pain.
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