BMC Anesthesiol. 2025 Dec 7. doi: 10.1186/s12871-025-03550-9. Online ahead of print.
ABSTRACT
BACKGROUND: Patients undergoing rotator cuff repair often experience moderate to severe postoperative pain. Interscalene brachial plexus block can provide analgesia and reduce opioid requirements. Bupivacaine is a standard anesthetic used for the brachial plexus block. Whether adding liposomal bupivacaine as an adjunct to bupivacaine-based brachial plexus block could improve analgesia and postoperative functional recovery remained unclear.
METHODS: A prospective, double-blind, randomized controlled clinical trial was conducted in patients scheduled for rotator cuff repair between September 2024 and March 2025. Eligible patients were randomized to receive either bupivacaine alone or a combination of bupivacaine with liposomal bupivacaine. The primary outcome was postoperative recovery measured by the quality of recovery-15 (QoR-15) scale at 24, 48, and 72 h after surgery. Secondary outcomes included perioperative measurements, pain intensity, muscle strength, and post-discharge functional evaluations. Complications were recorded.
RESULTS: A total of 113 patients (56 and 57 in the bupivacaine and combination groups, respectively) were included. Baseline characteristics were comparable between the two groups. Postoperative recovery was significantly better in the combination group than in the bupivacaine group at 48 h after surgery (P = 0.023). A greater proportion of patients in the combination group reported satisfaction than in the bupivacaine group (P = 0.023). The combination group also experienced significantly better pain relief at 12-, 24-, and 48-h but lower muscle strength between 6 and 48 h postoperatively than the bupivacaine group (all P < 0.01). Otherwise, there were no statistically significant differences between the two groups in intraoperative measurements, postoperative length of hospital stay, postoperative oxycodone consumption, heart rate, mean arterial pressure, complications, or post-discharge functional evaluations.
CONCLUSION: Adding liposomal bupivacaine to a standard bupivacaine-based brachial plexus block could safely improve postoperative recovery, pain relief, and patient satisfaction, but reduce muscle strength within 48 h after rotator cuff repair, without a significant impact on shoulder function after hospital discharge.
TRIAL REGISTRATION: Retrospectively registered, Chinese Clinical Trial Registry (registration number ChiCTR2500099378), registration date: March 21, 2025.
PMID:41353527 | DOI:10.1186/s12871-025-03550-9
