Does Liposomal Bupivacaine Provide Additional Postoperative Pain Control for Distal Radius Fracture Volar Plating Performed with a Supraclavicular Nerve Block?

Background

Distal radius fractures is an orthopedic injury commonly operatively treated with volar-based plating. Regional nerve blocks are efficacious in improving post-operative pain control, yet “rebound pain” when the nerve block wears off remains of great concern. This study aims to evaluate the efficacy of liposomal bupivacaine (LB) in providing meaningful, additional pain control on top of a supraclavicular nerve block for patients undergoing distal radius volar plating.

Methods

46 patients (≥18 years) with isolated distal radius fractures treated with open reduction and volar plating were prospectively enrolled. Patients received either supraclavicular nerve block alone (n=20) or supraclavicular nerve block with LB (n=26). Patients received the same post-operative pain management. Outcome measures were collected at baseline prior to surgery and included Pain Catastrophizing Score, Visual Analogue Scale (VAS) pain score, and QuickDASH. Follow-up VAS and QuickDASH scores were obtained 18h, 72h, 1 week, and 2 weeks post-operatively and compared to baseline.

Results

VAS and QuickDASH were worst at baseline and gradually improved over the 2 week follow-up period in the Block only and LB groups. Addition of LB did not provide a measurable benefit in VAS pain or QuickDASH function scores for patients undergoing volar plating for distal radius fracture with regional nerve block.

Conclusion

The added cost of LB may not be justified in patients who have already received a regional nerve block as the addition of LB did not significantly improve VAS pain or QuickDASH function scores. Future studies will evaluate standalone LB for distal radius volar plating.