Addition of Liposomal Bupivacaine to Standard Bupivacaine versus Standard Bupivacaine Alone in the Supraclavicular Brachial Plexus Block: A Randomized Controlled Trial.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

Anesthesiology Pub Date : 2024-10-01 DOI:10.1097/ALN.0000000000005035

Timmy Chi Wing Chan, Janus Siu Him Wong, Fengfeng Wang, Christian Xinshuo Fang, Colin Shing-Yat Yung, Manson Tak Hei Chan, Will Shing Him Chan, Stanley Sau Ching Wong

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引用次数: 0

Abstract

Background: The analgesic effect of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus block is not known. The authors hypothesized that addition of liposomal bupivacaine would reduce acute postoperative pain compared to standard bupivacaine alone.

Methods: A randomized controlled trial was conducted. Patients and outcome assessors were blinded. Eighty patients undergoing distal radial fracture fixation during regional anesthesia with supraclavicular brachial plexus block were randomized into two groups. The liposomal bupivacaine group received 10 ml 0.5% plain bupivacaine immediately followed by 10 ml 1.33% liposomal bupivacaine (n = 40). The standard bupivacaine group received 20 ml 0.5% plain bupivacaine (n = 40). The primary outcome was weighted area under curve (AUC) numerical rating scale pain score at rest during the first 48 h after surgery. Secondary outcomes included weighted AUC scores for pain with movement, overall benefit with analgesia score, and other functional scores.

Results: For the primary outcome, the liposomal bupivacaine group was associated with statistically significantly lower weighted AUC pain score at rest (0.6 vs. 1.4; P < 0.001) in the first 48 h. Of the secondary outcomes, no difference between treatment groups reached statistical significance with the exception of weighted AUC score for pain with movement (2.3 vs. 3.7; adjusted P < 0.001) and overall benefit with analgesia score (1.1 vs. 1.7; adjusted P = 0.020) in the first 48 h, as well as numerical rating scale pain score at rest (0.5 vs. 1.9; adjusted P < 0.001) and with movement (2.7 vs. 4.9; adjusted P < 0.001) on postoperative day 1. Differences in numerical rating scale pain scores on postoperative days 2, 3, and 4 did not reach the level of statistical significance. There were no statistically significant differences in sensory function.

Conclusions: Liposomal bupivacaine given via supraclavicular brachial plexus block reduced pain at rest in the early postoperative period.

Editor’s perspective:

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在锁骨上臂丛阻滞中，在标准布比卡因基础上添加脂质体布比卡因与单独使用标准布比卡因：随机对照试验。

背景：锁骨上臂丛神经阻滞术中，在标准布比卡因基础上添加脂质体布比卡因的镇痛效果尚不清楚。我们假设，与单独使用标准布比卡因相比，添加脂质体布比卡因可减轻术后急性疼痛：方法：我们进行了一项随机对照试验。患者和结果评估者均为盲人。在锁骨上臂丛阻滞区域麻醉下接受桡骨远端骨折固定术的 80 名患者被随机分为两组。脂质体布比卡因（LB-BPB）组立即注射10毫升0.5%普通布比卡因，然后注射10毫升1.33%脂质体布比卡因（n=40）。标准布比卡因（S-BPB）组接受20毫升0.5%普通布比卡因（40人）。主要结果是术后 48 小时内静息时的加权曲线下面积（AUC）数字评分量表（NRS）疼痛评分。次要结果包括活动时疼痛的 AUC 评分、镇痛总体获益评分（OBAS）和其他功能评分：就主要结果而言，LB-BPB 组术后 48 小时内静息时的 AUC 疼痛评分（0.6 vs 1.4，P 值<0.001）明显低于 LB-BPB 组，差异有统计学意义。在次要结果中，除了术后第 1 天（POD）活动时疼痛的 AUC 评分（2.3 vs 3.7，调整后的 P 值<0.001）和 OBAS（1.1 vs 1.7，调整后的 P 值=0.020），以及休息时（0.5 vs 1.9，调整后的 P 值<0.001）和活动时（2.7 vs 4.9，调整后的 P 值<0.001）的 NRS 疼痛评分外，治疗组之间的差异均未达到统计学意义。术后第 2 天、第 3 天和第 4 天的 NRS 疼痛评分差异未达到统计学显著性水平。在感觉功能方面，差异无统计学意义：结论：通过锁骨上臂丛阻滞给予脂质体布比卡因可减轻术后早期休息时的疼痛。

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.