---
title: "Liposomal Bupivacaine Plus Bupivacaine vs Bupivacaine ISB for Pain After Rotator Cuff Repair"
id: "pubmed-41468585"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41468585"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41468585/"
doi: "10.5435/JAAOS-D-25-01002"
published_at: "2026-08-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Liposomal Bupivacaine Plus Bupivacaine vs Bupivacaine ISB for Pain After Rotator Cuff Repair
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41468585
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41468585/)
- **DOI:** [10.5435/JAAOS-D-25-01002](https://doi.org/10.5435%2FJAAOS-D-25-01002)
- **Published At:** 2026-08-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This randomized, double-blinded, single-center trial compared **liposomal bupivacaine + bupivacaine (LBB)** versus **bupivacaine (B)** alone for ultrasound-guided interscalene nerve blocks (ISB) in opioid-naive patients undergoing arthroscopic rotator cuff repair (RCR). - The study enrolled 128 patients randomized 1:1 between January 2020 and April 2024; groups received either 25 mL of 0.5% bupivacaine (B) or 133 mg (10 mL) liposomal bupivacaine + 15 mL 0.5% bupivacaine (LBB). - Collected outcomes included patient demographics, comorbidities, concomitant procedures, daily opioid use converted to **morphine milligram equivalents (MME)**, and daily **visual analog scale (VAS)** pain scores for 14 postoperative days. - Baseline characteristics and ASA classification did not differ between groups. - On postoperative day 2, the LBB group had statistically lower median MME consumption and lower mean VAS score (P = 0.04 and P = 0.03, respectively). The reported numeric differences were small; the opioid-sparing effect corresponded to about one oxycodone tablet and the VAS difference did not reach a minimal clinically important difference. - No other significant differences were found in daily MME use, daily VAS scores, or total 14-day opioid consumption. Overall median opioid consumption over 14 days was low in both groups (reported as low total MME and equivalent to a small number of oxycodone pills). - Authors conclude that while LBB produced modest statistical improvements on POD2, these differences are not clinically notable; no sustained analgesic benefit was demonstrated over the first 2 postoperative weeks. - Trial registration: ClinicalTrials.gov NCT06139666. Level of evidence: I. Details such as specific adverse events, long-term outcomes, and subgroup analyses were not reported within the abstract.
## Clinical Analysis & Structured Key Points
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Epub 2025 Dec 24. # Liposomal Bupivacaine + Bupivacaine Versus Bupivacaine Interscalene Nerve Block Effect on Pain After Rotator Cuff Repair: A Randomized Control Trial [Catherine J Fedorka](https://pubmed.ncbi.nlm.nih.gov/?term=Fedorka+CJ&cauthor_id=41468585)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41468585/#full-view-affiliation-1 "From the Department of Orthopedic Surgery, Cooper University Health Care \(Fedorka, Rivera-Pintado, Gentile, Russo, Boniello, Hunter, and Kleiner\), the Cooper Medical School of Rowan University \(Tornberg, Hunter, Desai, Soni, Kleiner, and Dodson\), and the Department of Anesthesia, Cooper University Health Care, Camden, New Jersey \(Desai, Soni, and Dodson\)."), [Haley N Tornberg](https://pubmed.ncbi.nlm.nih.gov/?term=Tornberg+HN&cauthor_id=41468585), [Christopher Rivera-Pintado](https://pubmed.ncbi.nlm.nih.gov/?term=Rivera-Pintado+C&cauthor_id=41468585), [Pietro M Gentile](https://pubmed.ncbi.nlm.nih.gov/?term=Gentile+PM&cauthor_id=41468585), [Devyn Russo](https://pubmed.ncbi.nlm.nih.gov/?term=Russo+D&cauthor_id=41468585), [Michael Boniello](https://pubmed.ncbi.nlm.nih.gov/?term=Boniello+M&cauthor_id=41468585), [Krystal Hunter](https://pubmed.ncbi.nlm.nih.gov/?term=Hunter+K&cauthor_id=41468585), [Ronak Desai](https://pubmed.ncbi.nlm.nih.gov/?term=Desai+R&cauthor_id=41468585), [Dhiren Soni](https://pubmed.ncbi.nlm.nih.gov/?term=Soni+D&cauthor_id=41468585), [Matthew T Kleiner](https://pubmed.ncbi.nlm.nih.gov/?term=Kleiner+MT&cauthor_id=41468585), [Gregory Dodson](https://pubmed.ncbi.nlm.nih.gov/?term=Dodson+G&cauthor_id=41468585) Affiliations Expand ### Affiliation * 1 From the Department of Orthopedic Surgery, Cooper University Health Care (Fedorka, Rivera-Pintado, Gentile, Russo, Boniello, Hunter, and Kleiner), the Cooper Medical School of Rowan University (Tornberg, Hunter, Desai, Soni, Kleiner, and Dodson), and the Department of Anesthesia, Cooper University Health Care, Camden, New Jersey (Desai, Soni, and Dodson). * PMID: **41468585** * DOI: [ 10.5435/JAAOS-D-25-01002 ](https://doi.org/10.5435/jaaos-d-25-01002) Item in Clipboard Randomized Controlled Trial # Liposomal Bupivacaine + Bupivacaine Versus Bupivacaine Interscalene Nerve Block Effect on Pain After Rotator Cuff Repair: A Randomized Control Trial Catherine J Fedorka et al. J Am Acad Orthop Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID J Am Acad Orthop Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Am+Acad+Orthop+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Am+Acad+Orthop+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41468585/) . 2026 Aug 15;34(16):e2216-e2225. doi: 10.5435/JAAOS-D-25-01002. Epub 2025 Dec 24. ### Authors [Catherine J Fedorka](https://pubmed.ncbi.nlm.nih.gov/?term=Fedorka+CJ&cauthor_id=41468585)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41468585/#short-view-affiliation-1 "From the Department of Orthopedic Surgery, Cooper University Health Care \(Fedorka, Rivera-Pintado, Gentile, Russo, Boniello, Hunter, and Kleiner\), the Cooper Medical School of Rowan University \(Tornberg, Hunter, Desai, Soni, Kleiner, and Dodson\), and the Department of Anesthesia, Cooper University Health Care, Camden, New Jersey \(Desai, Soni, and Dodson\)."), [Haley N Tornberg](https://pubmed.ncbi.nlm.nih.gov/?term=Tornberg+HN&cauthor_id=41468585), [Christopher Rivera-Pintado](https://pubmed.ncbi.nlm.nih.gov/?term=Rivera-Pintado+C&cauthor_id=41468585), [Pietro M Gentile](https://pubmed.ncbi.nlm.nih.gov/?term=Gentile+PM&cauthor_id=41468585), [Devyn Russo](https://pubmed.ncbi.nlm.nih.gov/?term=Russo+D&cauthor_id=41468585), [Michael Boniello](https://pubmed.ncbi.nlm.nih.gov/?term=Boniello+M&cauthor_id=41468585), [Krystal Hunter](https://pubmed.ncbi.nlm.nih.gov/?term=Hunter+K&cauthor_id=41468585), [Ronak Desai](https://pubmed.ncbi.nlm.nih.gov/?term=Desai+R&cauthor_id=41468585), [Dhiren Soni](https://pubmed.ncbi.nlm.nih.gov/?term=Soni+D&cauthor_id=41468585), [Matthew T Kleiner](https://pubmed.ncbi.nlm.nih.gov/?term=Kleiner+MT&cauthor_id=41468585), [Gregory Dodson](https://pubmed.ncbi.nlm.nih.gov/?term=Dodson+G&cauthor_id=41468585) ### Affiliation * 1 From the Department of Orthopedic Surgery, Cooper University Health Care (Fedorka, Rivera-Pintado, Gentile, Russo, Boniello, Hunter, and Kleiner), the Cooper Medical School of Rowan University (Tornberg, Hunter, Desai, Soni, Kleiner, and Dodson), and the Department of Anesthesia, Cooper University Health Care, Camden, New Jersey (Desai, Soni, and Dodson). * PMID: **41468585** * DOI: [ 10.5435/JAAOS-D-25-01002 ](https://doi.org/10.5435/jaaos-d-25-01002) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Interscalene nerve blocks (ISB) are commonly used for perioperative pain control after shoulder arthroscopy. Bupivacaine has historically been the primary anesthetic used in ISBs. In 2018, the U.S. Food and Drug Administration approved liposomal bupivacaine for ISBs. This study aims to identify the effect of ISBs using bupivacaine alone (B) versus liposomal bupivacaine + bupivacaine (LBB) on postoperative pain control after arthroscopic rotator cuff repair (RCR). **Methods:** A single-center, prospective, double-blinded, randomized, control trial following Consolidated Standards of Reporting guidelines was conducted from January 2020 to April 2024; 128 opiate naive patients undergoing arthroscopic RCR were randomized 1:1 into the B-only group (25 cc of 0.5% bupivacaine) versus the LBB group (133 mg [10 mL] of liposomal bupivacaine + 15 cc 0.5% bupivacaine). Demographics, comorbidities, additional procedures performed, daily morphine milligram equivalents (MME) consumed, and daily visual analog scale (VAS) pain scores for 14 days were collected. **Results:** No differences were noted between age, sex, comorbidities, or American Society of Anesthesiologists physical classification system scores. On postoperative day 2, the LBB group consumed markedly lower MMEs (0.0 [0.0 to 7.5] versus 0.0 [0.0 to 15.0]; [ P = 0.04]) and demonstrated a notable improvement in VAS scores on postoperative day 2 (4.8 ± 3.0 versus 6.0 ± 2.8; [ P = 0.03]). No notable difference was seen in other daily MMEs consumed, daily VAS scores, or total 14-day MMEs. Total median MME consumed in both groups was low (MME 35.6 [7.5 to 88.1] or 5 [1 to 12] oxycodone pills). **Conclusion:** Although the use of LBB in ISBs led to markedly lower VAS scores and less narcotic consumption on postoperative day (POD2), these findings can be regarded as not clinically notable. The difference was the equivalent of one oxycodone tablet, and VAS did not meet minimal clinically important difference. No other differences were found in MME consumed or VAS scores during the first 2 weeks postoperatively following RCR. Overall narcotic consumption was low in both groups. **Level of evidence:** I. **Trial registration:** ClinicalTrials.gov [NCT06139666](http://clinicaltrials.gov/show/NCT06139666 "See in ClinicalTrials.gov"). Copyright © 2025 by the American Academy of Orthopaedic Surgeons. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Periarticular liposomal bupivacaine mixture injection vs. single-shot interscalene block for postoperative pain in arthroscopic rotator cuff repair: a prospective randomized controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/34537339/) Hillesheim RA, Kumar P, Brolin TJ, Bernholt DL, Sethi PM, Kowalsky MS, Azar FM, Throckmorton TW.Hillesheim RA, et al.J Shoulder Elbow Surg. 2021 Dec;30(12):2691-2697. doi: 10.1016/j.jse.2021.08.012. Epub 2021 Sep 16.J Shoulder Elbow Surg. 2021.PMID: 34537339Clinical Trial. * [ Liposomal bupivacaine infiltration in the surgical site for analgesia after rotator cuff repair: a randomized, double-blinded, placebo-controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/33290853/) Verdecchia NM, Rodosky MW, Kentor M, Orebaugh SL.Verdecchia NM, et al.J Shoulder Elbow Surg. 2021 May;30(5):986-993. doi: 10.1016/j.jse.2020.10.035. Epub 2020 Dec 5.J Shoulder Elbow Surg. 2021.PMID: 33290853Clinical Trial. * [ Effect of ultrasound-guided interscalene brachial plexus block using liposome bupivacaine combined with continuous esketamine infusion on quality of recovery in patients undergoing arthroscopic rotator cuff repair: study protocol for a randomized controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/42121214/) Yue J, Wang Q, Tang Q, Zhou R, Zhou L.Yue J, et al.Trials. 2026 May 13;27(1):468. doi: 10.1186/s13063-026-09784-3.Trials. 2026.PMID: 42121214Free PMC article. * [ Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies. ](https://pubmed.ncbi.nlm.nih.gov/39971098/) Hardrick J, Ifarraguerri AM, Collins MS, Trofa DP, Fleischli JE, Hamid N, Siparsky PN, Saltzman BM.Hardrick J, et al.Orthop Traumatol Surg Res. 2026 Feb;112(1):104190. doi: 10.1016/j.otsr.2025.104190. Epub 2025 Feb 17.Orthop Traumatol Surg Res. 2026.PMID: 39971098 * [ Efficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/31324503/) Kolade O, Patel K, Ihejirika R, Press D, Friedlander S, Roberts T, Rokito AS, Virk MS.Kolade O, et al.J Shoulder Elbow Surg. 2019 Sep;28(9):1824-1834. doi: 10.1016/j.jse.2019.04.054. Epub 2019 Jul 16.J Shoulder Elbow Surg. 2019.PMID: 31324503 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=41468585) ## References 1. 1. Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS: Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016;25:1204-1213. 2. 1. Beecroft CL, Coventry DM: Anaesthesia for shoulder surgery. Continuing Educ Anaesth Crit Care Pain 2008;8:193-198. 3. 1. Fredrickson MJ, Krishnan S, Chen CY: Postoperative analgesia for shoulder surgery: A critical appraisal and review of current techniques. Anaesthesia 2010;65:608-624. 4. 1. Kahn RL, Cheng J, Gadulov Y, Fields KG, YaDeau JT, Gulotta LV: Perineural low-dose dexamethasone prolongs interscalene block analgesia with bupivacaine compared with systemic dexamethasone: A randomized trial. Reg Anesth Pain Med 2018;43:572-579. 5. 1. Cummings KC III, Napierkowski DE, Parra-Sanchez I, et al.: Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth 2011;107:446-453. 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