Best Practices for Periarticular Infiltration With Liposomal Bupivacaine for the Management of Pain After Shoulder Surgery: Consensus Recommendation

Girish P. Joshi, Richard J. Hawkins, Mark A. Frankle, Jeffrey S. Abrams

Research output: Contribution to journalReview article

7 Scopus citations

Abstract

Postsurgical pain, like that associated with major upper extremity surgery, can be significant and usually require the use of opioid analgesics. However, opioids are associated with significant adverse effects, including respiratory depression, which often drive the use of multimodal therapy with nonopioid analgesics, including local and regional analgesia techniques. However, use of older local anesthetics provides a limited duration of analgesia. An innovative formulation of liposomal bupivacaine (Exparel), which is approved for surgical site infiltration, can provide a longer duration of analgesia. Because optimal pain relief relies on the success of the surgical site infiltration technique, a group convened to address best practices for periarticular injection techniques for shoulder surgery. This article reviews the neuroanatomy of the shoulder, recommends optimal solutions (i.e., analgesic cocktails) and volume for injection, and provides a detailed description of the infiltration technique to develop the best approach to periarticular injection for major shoulder surgery.

Original languageEnglish (US)
Pages (from-to)204-208
Number of pages5
JournalJournal of surgical orthopaedic advances
Volume25
Issue number4
StatePublished - Jan 1 2016

ASJC Scopus subject areas

  • Medicine(all)

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