Dexamethasone has a synergistic effect on liposomal bupivacaine in reducing postoperative pain after total shoulder arthroplasty

Abstract

Background

Multimodal approaches to address postoperative pain after total shoulder arthroplasty (TSA) are becoming the standard of care. The combined use of dexamethasone and liposomal bupivacaine (LB) may be an effective method to enhance analgesia. We assess if the addition of dexamethasone to TSA patients receiving LB results in reduced opiate needs and shorter length of stay.

Methods

The Premier Healthcare Database was queried from January 1, 2016, to December 31, 2020, for patients who underwent primary, elective anatomic/reverse TSA and received local infiltration LB. Patients were then propensity matched on the probability of receiving dexamethasone. After matching, multivariable models, including all other available multimodal analgesic medications, were generated to evaluate the association between dexamethasone and morphine milligram equivalent intake and length of stay.

Results

A total of 3445 patients remained in each group after matching and were well balanced for covariates (standardized mean difference <0.1). A significant difference in total opioid consumption was observed between groups (median = 36.6 mg vs. 42.5 mg, P < .001), with a significant negative correlation between morphine milligram equivalents used and dexamethasone exposure for total opioid use (β = −4.61, 95% confidence interval [CI] = −8.60 to −0.62), postoperative days 1 (β = −2.51, 95% CI = −3.40 to −1.66) and 2 (β = −2.09, 95% CI = −3.86 to −0.32). The adjusted odds of a length of stay beyond 1 day were significantly lower in the dexamethasone-treated group (adjusted odds ratio = 0.64, 95% CI = 0.56-0.73).

Conclusion

Dexamethasone reduces postoperative narcotic use after TSA and reduces length of stay. With increasing pressures to reduce opiate use, these data highlight alternative medication combinations, which may be used to promote this goal.