“It is an honor to receive the Health Care Heroes Lifetime Achievement Award. It has special meaning for me, as it recognizes my accomplishments in improving orthopedic care for people on Long Island and my work in educating many orthopedic surgeons now practicing here,” Dr. Dines said. “It represents a wonderful affirmation that I've been able to make a difference in the lives of many Long Islanders over the years.”

Over his 45-year career, Dr. Dines earned a reputation as a skilled and meticulous orthopedic surgeon; a brilliant thought leader; and an inspirational mentor to hundreds of medical students, orthopedic residents and fellows. He has provided the highest quality care to thousands of Long Islanders to help them overcome pain and return to active, healthy lifestyles.

Dr. Dines is a member of the Sports Medicine Institute at HSS and sees patients at HSS Long Island in Uniondale. He serves as medical director of the HSS Education Institute and has held the position of co-chief of the highly regarded shoulder fellowship at HSS since 2017. 

Considered one of the foremost authorities in shoulder replacement surgery worldwide, Dr. Dines has pioneered innovative techniques and surgical implants. Known for his work with professional athletes, he has served as medical director of the Association of Tennis Professionals (ATP) Tour since 2000. He was a team physician for the Long Island Ducks baseball team from 2000 to 2020, and for the New York Mets from 1992 to 1996. 

Dr. Dines has received a number of awards over the years. In 2024, the Middle Atlantic Shoulder and Elbow Society honored him with its Lifetime Achievement Award. He continues to conduct research to advance the field of joint replacement surgery.  

The U.S. Food & Drug Administration recently approved liposomal bupivacaine for use in interscalene nerve blocks. Liposomal bupivacaine is an extended-release formulation of bupivacaine that theoretically sustains pain relief up to 72 hours. However, there is a lack of randomized controlled trials comparing liposomal bupivacaine with placebo (saline) or with “standard” bupivacaine. 

Investigators aimed to determine whether liposomal bupivacaine actually prolongs pain relief compared with standard bupivacaine plus dexamethasone as a regional anesthetic technique. HSS has been using standard bupivacaine with perineural dexamethasone as an adjuvant in order to lengthen pain relief from nerve blocks up to 30 hours, as there are several meta-analyses and systematic reviews supporting its safe and effective use in upper extremity blockade. This study is the first randomized controlled trial comparing the two drugs as injectates in nerve blocks.

Study on prolonging nerve blocks is imperative, as “prolonging analgesia with adjuvants may be key in decreasing opioid use after surgery,” said Dr. David Kim, anesthesiologist at HSS.

The study was conducted from August 2019 to March 2021 in 112 patients undergoing ambulatory shoulder surgery. Participants were divided into two groups: 56 patients who received a mixture of 5 mL of 0.5% standard bupivacaine with 133 mg of liposomal bupivacaine; and 55 patients who received a mixture of 15 mL of 0.5% standard bupivacaine with 4 mg of dexamethasone. 

The primary outcome was average numerical rating scale (NRS) pain scores at rest over a period of 72 hours, but the researchers also examined analgesic block duration, motor and sensory resolution, opioid use, and NRS pain scale scores when resting and moving on days 1, 4 and 7 after surgery. They also examined patient satisfaction, readiness for PACU discharge, and adverse side effects related to the interscalene block. 

The results indicated that the pain score after 72 hours in the liposomal bupivacaine group was non-inferior to the bupivacaine with dexamethasone group (mean (SD), 2.4 (1.9) versus 3.4 (1.9), mean difference (95%CI), -1.1 (-1.8, -0.4), p <0.001 for noninferiority). Additionally, there was also no significant difference in the length of pain relief between the two groups. Furthermore, there was no difference in opioid consumption, readiness for PACU discharge, or adverse events. 

“Liposomal bupivacaine is noninferior to preservative-free dexamethasone when used as an adjuvant for the interscalene nerve block,” Dr. Kim noted. “Even though there was a statistically significant difference in the pain scores, the differences are unlikely to be clinically relevant. As practicing clinicians, it was important for us to investigate interventions that provide meaningful clinical differences, not to only look for statistical significance in numbers.”

Dr. Kim concluded “Follow up research should include a large prospective randomized controlled trial comparing liposomal bupivacaine and preservative-free dexamethasone on total shoulder arthroplasties.”

Reference

1. Danya A. DeMeo BS, Ejiro Gbaje MPH, Jacques T. YaDeau MD PhD, Kethy M. Jules-Elysee MD, Yi Lin MD PhD, Enrique A. Goytizolo MD, David Kim MD, Richard L Kahn MD, Stephen C. Haskins MD, David J. Mayman MD, Douglas E. Padgett MD, Thomas P. Sculco MD, Chad M. Brummett MD, Geoffrey Westrich MD. “Interscalene brachial plexus block with liposomal bupivacaine versus standard bupivacaine with perineural dexamethasone: a noninferiority trial.” Presented at: 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 31-April 2, 2021; Las Vegas, NV.