Has the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block

Purpose of review Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself. Recent findings Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative opioids. Both dexmedetomidine and dexamethasone effectively extend the duration of single injection ISB. Liposomal bupivacaine holds promise when injected perineurally in ISB, either as a sole agent or when mixed with standard bupivacaine. Interscalene catheters, adjunctive drugs added to local anesthetics in single-injection interscalene brachial plexus blocks, or liposomal bupivacaine may be used to effectively prolong the duration of analgesia for shoulder surgery patients.