{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:01:36Z","timestamp":1791910896212,"version":"4.3.4"},"reference-count":27,"publisher":"BMJ","issue":"1","funder":[{"name":"Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA","award":["None"],"award-info":[{"award-number":["None"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2022,10,11]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Interscalene brachial plexus blocks are a commonly performed procedure to reduce pain following total shoulder arthroplasty. Liposomal bupivacaine has been purported to prolong the duration of brachial plexus blocks for up to 72 hours; however, there has been controversy surrounding the analgesic benefits of this drug. Our hypothesis was that an interscalene block performed with bupivacaine alone would be non-inferior to a combination of liposomal bupivacaine and bupivacaine with respect to opioid consumption following total shoulder arthroplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Subjects presenting for primary total shoulder arthroplasty were randomized in a 1:1 ratio to an ultrasound-guided, single-injection interscalene block with either a combination of liposomal bupivacaine and bupivacaine (LB group) or bupivacaine without additive (Bupi group). The primary outcome of this study was 72-hour postoperative cumulative opioid consumption (in oral morphine equivalents) with a non-inferiority margin of 22.5\u2009mg. Secondary outcomes included pain scores, patient satisfaction with analgesia and patient reported duration of sensory block.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-six subjects, 38 from the Bupi group and 38 from the LB group, completed the study. Analysis of the primary outcome showed a 72-hour cumulative geometric mean oral morphine equivalent consumption difference of 11.9\u2009mg (95% CI \u22126.9 to 30.8) between groups (calculated on the log scale). This difference constitutes approximately 1.5 tablets of oxycodone over 3\u2009days. No secondary outcomes showed meaningful differences between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Interscalene brachial plexus blocks performed with bupivacaine alone did not demonstrate non-inferiority compared to a mixture of liposomal bupivacaine plus bupivacaine with regards to 72-hour cumulative opioid consumption following total shoulder arthroplasty. However, the difference between groups did not appear to be clinically meaningful.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2022-103997","type":"journal-article","created":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T13:00:39Z","timestamp":1666184439000},"page":"1-6","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Comparing bupivacaine alone to liposomal bupivacaine plus bupivacaine in interscalene blocks for total shoulder arthroplasty: a randomized, non-inferiority trial"],"prefix":"10.1136","volume":"48","clinical-trial-number":[{"clinical-trial-number":"nct04974385","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Donald A","family":"Elmer","sequence":"first","affiliation":[{"name":"Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Coleman","sequence":"additional","affiliation":[{"name":"Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian M","family":"Renwick","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E","family":"Amato","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C","family":"Werner","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen F","family":"Brockmeier","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April E","family":"Slee","sequence":"additional","affiliation":[{"name":"Comprehensive Clinical Trials Unit, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7449-8652","authenticated-orcid":false,"given":"Neil A","family":"Hanson","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,19]]},"reference":[{"key":"2025101111430118000_48.1.1.1","doi-asserted-by":"crossref","first-page":"e233","DOI":"10.5435\/JAAOS-D-21-00562","article-title":"Safety and cost effectiveness of outpatient total shoulder arthroplasty: a systematic review","volume":"30","author":"Calkins","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"2025101111430118000_48.1.1.2","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-00115550-199823050-00007"},{"key":"2025101111430118000_48.1.1.3","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1213\/ANE.0000000000000688","article-title":"Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis","volume":"120","author":"Abdallah","year":"2015","journal-title":"Anesth Analg"},{"key":"2025101111430118000_48.1.1.4","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1213\/ANE.0000000000005640","article-title":"The facilitatory effects of adjuvant pharmaceutics to prolong the duration of local anesthetic for peripheral nerve block: a systematic review and network meta-analysis","volume":"133","author":"Xuan","year":"2021","journal-title":"Anesth Analg"},{"key":"2025101111430118000_48.1.1.5","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200611000-00022"},{"key":"2025101111430118000_48.1.1.6","doi-asserted-by":"publisher","DOI":"10.2174\/1874321801509010001"},{"key":"2025101111430118000_48.1.1.7","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/joacp.JOACP_375_15","article-title":"Emerging roles of liposomal bupivacaine in anesthesia practice","volume":"33","author":"Malik","year":"2017","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025101111430118000_48.1.1.8","doi-asserted-by":"crossref","first-page":"3557","DOI":"10.1016\/j.arth.2017.03.017","article-title":"Liposomal bupivacaine mixture has similar pain relief and significantly fewer complications at less cost compared to indwelling interscalene catheter in total shoulder arthroplasty","volume":"32","author":"Weller","year":"2017","journal-title":"J Arthroplasty"},{"key":"2025101111430118000_48.1.1.9","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000560"},{"key":"2025101111430118000_48.1.1.10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/ALN.0000000000003651","article-title":"Perineural liposomal bupivacaine is not superior to nonliposomal bupivacaine for peripheral nerve block analgesia","volume":"134","author":"Hussain","year":"2021","journal-title":"Anesthesiology"},{"key":"2025101111430118000_48.1.1.11","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-102427"},{"key":"2025101111430118000_48.1.1.12","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1016\/j.jse.2019.04.054","article-title":"Efficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis","volume":"28","author":"Kolade","year":"2019","journal-title":"J Shoulder Elbow Surg"},{"key":"2025101111430118000_48.1.1.13","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000578"},{"key":"2025101111430118000_48.1.1.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.06.004"},{"key":"2025101111430118000_48.1.1.15","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jse.2020.09.017","article-title":"Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: a double-blinded prospective randomized control trial","volume":"30","author":"Hattrup","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"key":"2025101111430118000_48.1.1.16","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2021-102973"},{"key":"2025101111430118000_48.1.1.17","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000692"},{"key":"2025101111430118000_48.1.1.18","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/52.3-4.591"},{"key":"2025101111430118000_48.1.1.19","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1214\/aoms\/1177732594","article-title":"The limiting distributions of certain statistics","volume":"6","author":"Doob","year":"1935","journal-title":"Ann. 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EXPAREL is a cost-effective option for postsurgical pain management in the hospital and ambulatory (outpatient) settings; 2022. https:\/\/www.exparel.com\/hcp\/value\/total-hip-arthroplasty [Accessed 06 Sept 2022]."},{"key":"2025101111430118000_48.1.1.23","doi-asserted-by":"crossref","DOI":"10.1136\/rapm-2021-103349","article-title":"Comparing liposomal bupivacaine plus bupivacaine to bupivacaine alone in interscalene blocks for rotator cuff repair surgery: a randomized clinical trial","volume":"47","author":"Flaherty","year":"2022","journal-title":"Reg Anesth Pain Med"},{"key":"2025101111430118000_48.1.1.24","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.2106\/JBJS.20.00225","article-title":"Single-shot liposomal bupivacaine reduces postoperative narcotic use following outpatient rotator cuff repair: a prospective, double-blinded, randomized controlled trial","volume":"102","author":"Baessler","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2025101111430118000_48.1.1.25","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/ALN.0000000000004111","article-title":"Interscalene brachial plexus block with liposomal bupivacaine versus standard bupivacaine with perineural dexamethasone: a noninferiority trial","volume":"136","author":"Kim","year":"2022","journal-title":"Anesthesiology"},{"key":"2025101111430118000_48.1.1.26","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/ALN.0000000000004118","article-title":"Evaluation of diaphragmatic function after interscalene block with liposomal bupivacaine: a randomized controlled trial","volume":"136","author":"Berg","year":"2022","journal-title":"Anesthesiology"},{"key":"2025101111430118000_48.1.1.27","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002283"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2022-103997","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:43:09Z","timestamp":1760208189000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2022-103997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,19]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,11,23]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/rapm-2022-103997"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2022-103997","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,19]]}}}