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Meta-Analysis
. 2023 Mar 16;18(1):206.
doi: 10.1186/s13018-023-03699-4.

Liposomal bupivacaine administration is not superior to traditional periarticular injection for postoperative pain management following total knee arthroplasty: a meta-analysis of randomized controlled trials

Jian-Jiun Chen  1 , Yun-Che Wu  2 , Jun-Sing Wang  3   4   5 , Cheng-Hung Lee  6   7   8
Affiliations
Meta-Analysis

Liposomal bupivacaine administration is not superior to traditional periarticular injection for postoperative pain management following total knee arthroplasty: a meta-analysis of randomized controlled trials

Jian-Jiun Chen et al. J Orthop Surg Res. .

Abstract

Background: Liposomal bupivacaine (LB) is a relatively new formulation that slowly releases bupivacaine to extend its efficacy for 72-96 h. It is inconclusive whether LB offers better efficacy than traditional periarticular injection (TPAI) following total knee arthroplasty (TKA).

Methods: Relevant randomized controlled trials (RCTs) were searched using electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. Review Manager 5.4.1 was used for calculations.

Results: Sixteen RCTs were included in this meta-analysis. LB had better effects on morphine consumption equivalents during postoperative 24-48 h than TPAI. No significant difference was observed in pain relief, incidence of nausea and vomiting, or length of hospital stay between the two groups.

Conclusion: LB administration during TKA is not superior to TPAI. Studies with larger sample size are needed to validate our findings. PROSPERO registration number: CRD42022355094.

Keywords: Liposomal bupivacaine; Total knee arthroplasty; Traditional periarticular injection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of literature selection procedure
Fig. 2
Fig. 2
Methodological quality of included studies
Fig. 3
Fig. 3
Risk-of-bias assessment of included studies
Fig. 4
Fig. 4
Funnel plot of VAS score. VAS POD1 of Declaire 2017 was not included in the funnel plot due to extremely high standard error (MD = 0.69, SE = 3.08)
Fig. 5
Fig. 5
Forest plot of the VAS during postoperative day. From top to bottom are POD 0, POD1, POD2 and POD3
Fig. 6
Fig. 6
Forest plot of morphine consumption equivalents. From top to bottom are postoperative 0–24 h, 24–48 h and 48–72 h
Fig. 7
Fig. 7
Forest plot of nausea and vomiting incidence
Fig. 8
Fig. 8
Forest plot of length of hospital stay
See this image and copyright information in PMC

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