The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks: A systematic review and meta-analysis, with trial sequential analysis

Abstract

Background: Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively.

Objectives: To compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks.

Design: A systematic review and meta-analysis with trial sequential analysis.

Data sources: MEDLINE, Embase and Web of Science, among others, up to June 2022.

Eligibility criteria: We retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24 h. Secondary endpoints included rest pain score at 48 and 72 h, and morphine consumption at 24, 48 and 72 h.

Results: Twenty-seven trials including 2122 patients were identified. Rest pain scores at 24 h were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I2 = 87%, P < 0.001. This reduction in pain scores persisted at 48 h and 72 h with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I2 = 82%, P = 0.001 and -0.7 (-1.1 to -0.3), I2 = 80%, P < 0.001, respectively. There were no differences in interval morphine consumption at 24 h ( P = 0.15), 48 h ( P = 0.15) and 72 h ( P = 0.07). The quality of evidence was moderate.

Conclusions: There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.

Fig. 1

PRISMA flow diagram showing literature search results. Twenty-seven randomised controlled trials were included in the analysis.

Fig. 2

Cochrane collaboration risk of bias summary: evaluation of bias risk items for each included study. Green circle, low risk of bias; red circle, high risk of bias; yellow circle, unclear risk of bias.

Fig. 3

Rest pain score at 24 postoperative hours in patients receiving liposomal bupivacaine or long-acting local anaesthetics (bupivacaine, ropivacaine) analysed according to peripheral nerve versus field blocks. LA, local anaesthetics.