The Efficacy of Liposomal Bupivacaine in Managing Postoperative Pain, a Systematic Review and Meta-Analysis of Randomized Control Trials

Authors

  • Helena Soares Da Silva Southern Medical University
  • Hualei Gong Southern Medical University
  • Wenbo Wu Southern Medical University
  • Zhenning Fang Southern Medical University
  • Kai Mo Southern Medical University

DOI:

https://doi.org/10.58344/jws.v4i3.1376

Keywords:

efficacy and safety, Liposomal Bupivacaine, Opioid reduction, postoperative analgesia, RCT

Abstract

Postoperative pain, a significant surgical complication, presents a considerable challenge to the healthcare system, resulting in adverse outcomes, disability, prolonged hospitalization, and financial strain. This study seeks to evaluate the effectiveness of liposomal bupivacaine (LB) in postoperative pain management by a systematic review and meta-analysis of existing research. PubMed, CENTRAL, Embase, Web of Science, and Google Scholar were searched for randomized controlled trials (RCTs) published until January 2025, focusing on adults (18 years) undergoing surgical procedures where LB was administered via wound infiltration, nerve blocks, or periarticular injections. Primary outcomes included pain scores (VAS/NRS/BPI), opioid consumption, adverse events (e.g., nausea/vomiting), and patient satisfaction. A total of 763 papers were discovered in the literature, of which 21 (Barrington et al., 2017) were included. The pooled standardized mean difference (SMD) was -0.53, (95% CI, [-0.84, -0.23]; p = 0.0006) signifying a statistically significant decrease in pain levels favoring the intervention group. No significant disparity in opioid use was found between the two groups. The combined odds ratio (OR) was 0.78 (95% confidence interval (CI): [0.46 to 1.31]; [p = 0.35), indicating no significant difference in the incidence of nausea and vomiting. LB is effective in alleviating pain, diminishing opiate usage, and alleviating postoperative side effects.

References

Barrington, J. W., Emerson, R. H., Lovald, S. T., Lombardi, A. V., & Berend, K. R. (2017). No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. Clinical Orthopaedics and Related Research, 475(1). https://doi.org/10.1007/s11999-016-4931-z

Brown, S. L., & Morrison, A. E. (2004). Local Anesthetic Infusion Pump Systems Adverse Events Reported to the Food and Drug Administration. Anesthesiology, 100(5). https://doi.org/10.1097/00000542-200405000-00036

Cao, X., & Pan, F. (2017). Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty: A meta-analysis of randomized control trails. Medicine (United States), 96(39). https://doi.org/10.1097/MD.0000000000008079

Chen, J. J., Wu, Y. C., Wang, J. S., & Lee, C. H. (2023). 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. Journal of Orthopaedic Surgery and Research, 18(1). https://doi.org/10.1186/s13018-023-03699-4

Cox, S. G., Vicinanzo, M. G., Jacobs, S. M., Scruggs, J., & Long, J. A. (2022). Liposomal Bupivacaine Suspension for Pain Control Following Ocular Evisceration Surgery. Ophthalmic Plastic and Reconstructive Surgery, 38(3). https://doi.org/10.1097/IOP.0000000000002060

DInges, H. C., Wiesmann, T., Otremba, B., Wulf, H., Eberhart, L. H., & Schubert, A. K. (2021). The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: A systematic review and meta-analysis with trial sequential analysis. Regional Anesthesia and Pain Medicine, 46(6). https://doi.org/10.1136/rapm-2020-102427

Egan, K. G., Guest, R., Sinik, L. M., Nazir, N., De Ruyter, M., Ponnuru, S., & Bhavsar, D. (2021). Evaluation of Liposomal Bupivacaine at Split-Thickness Skin Graft Donor Sites through a Randomized, Controlled Trial. Journal of Burn Care and Research, 42(6). https://doi.org/10.1093/jbcr/irab129

Elmer, D. A., Coleman, J. R., Renwick, C. M., Amato, P. E., Werner, B. C., Brockmeier, S. F., Slee, A. E., & Hanson, N. A. (2022). Comparing bupivacaine alone to liposomal bupivacaine plus bupivacaine in interscalene blocks for total shoulder arthroplasty: a randomized, non-inferiority trial. Regional Anesthesia and Pain Medicine, 48(1). https://doi.org/10.1136/rapm-2022-103997

Fidkowski, C. W., Choksi, N., & Alsaden, M. R. (2021). A randomized-controlled trial comparing liposomal bupivacaine, plain bupivacaine, and the mixture of liposomal bupivacaine and plain bupivacaine in transversus abdominus plane block for postoperative analgesia for open abdominal hysterectomies. Canadian Journal of Anesthesia, 68(6). https://doi.org/10.1007/s12630-020-01911-1

Gan, T. J. (2017). Poorly controlled postoperative pain: Prevalence, consequences, and prevention. Journal of Pain Research, 10. https://doi.org/10.2147/JPR.S144066

Gerbershagen, H. J., Aduckathil, S., van Wijck, A. J. M., Peelen, L. M., Kalkman, C. J., & Meissner, W. (2013). Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology, 118(4).

Hadzic, A., Minkowitz, H. S., Melson, T. I., Berkowitz, R., Uskova, A., Ringold, F., Lookabaugh, J., & Ilfeld, B. M. (2016). Liposome bupivacaine femoral nerve block for postsurgical analgesia after total knee arthroplasty. Anesthesiology, 124(6). https://doi.org/10.1097/ALN.0000000000001117

Hamilton, T. W., Knight, R., Stokes, J. R., Rombach, I., Cooper, C., Davies, L., Dutton, S. J., Barker, K. L., Cook, J., Lamb, S. E., Murray, D. W., Poulton, L., Wang, A., Strickland, L. H., Van Duren, B. H., Leal, J., Beard, D., & Pandit, H. G. (2022). Efficacy of Liposomal Bupivacaine and Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Periarticular Anesthetic for Patients Undergoing Knee Replacement: A Randomized Clinical Trial. JAMA Surgery, 157(6). https://doi.org/10.1001/jamasurg.2022.0713

Hattrup, S. J., Chung, A. S., Rosenfeld, D. M., Misra, L., Koyyalamudi, V., Ritz, M. L., & Tokish, J. M. (2021). Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: a double-blinded prospective randomized control trial. Journal of Shoulder and Elbow Surgery, 30(3). https://doi.org/10.1016/j.jse.2020.09.017

Hubler, C. P., Bevil, K. M., Greiner, J. J., Hetzel, S. J., Borden, S. B., & Cios, H. A. (2021). Liposomal bupivacaine versus standard bupivacaine in the adductor canal for total knee arthroplasty: A randomized, controlled trial. Orthopedics, 44(4). https://doi.org/10.3928/01477447-20210621-01

Hungerford, M., Neubauer, P., Ciotola, J., Littleton, K., Boner, A., & Chang, L. (2021). Liposomal Bupivacaine vs Ropivacaine for Adductor Canal Blocks in Total Knee Arthroplasty: A Prospective Randomized Trial. Journal of Arthroplasty, 36(12). https://doi.org/10.1016/j.arth.2021.08.017

James, J., Benton, B., Faigen, A., Bloomquist, R., Farmaha, J., & Hollingsworth, C. (2023). Pain Levels Did Not Differ Following Uncomplicated Third Molar Extractions Utilizing Liposomal Bupivacaine Versus Standard Bupivacaine. Journal of Oral and Maxillofacial Surgery, 81(2). https://doi.org/10.1016/j.joms.2022.09.015

Jiang, H., Ma, Q., Dong, J., & Ye, X. (2023). The effect of liposomal bupivacaine for surgical wound infiltration: A meta-analysis of randomised controlled trials. International Wound Journal, 20(5). https://doi.org/10.1111/iwj.14015

Kim, D. H., Liu, J., Beathe, J. C., Lin, Y., Wetmore, D. S., Kim, S. J., Haskins, S. C., Garvin, S., Oxendine, J. A., Ho, M. C., Allen, A. A., Popovic, M., Gbaje, E., Wu, C. L., & Memtsoudis, S. G. (2022). Interscalene Brachial Plexus Block with Liposomal Bupivacaine versus Standard Bupivacaine with Perineural Dexamethasone: A Noninferiority Trial. Anesthesiology, 136(3). https://doi.org/10.1097/ALN.0000000000004111

Kolade, O., Patel, K., Ihejirika, R., Press, D., Friedlander, S., Roberts, T., Rokito, A. S., & Virk, M. S. (2019). Efficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery, 28(9). https://doi.org/10.1016/j.jse.2019.04.054

Kuang, M. jie, Du, Y., Ma, J. xiong, He, W., Fu, L., & Ma, X. long. (2017). The Efficacy of Liposomal Bupivacaine Using Periarticular Injection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Journal of Arthroplasty, 32(4). https://doi.org/10.1016/j.arth.2016.12.025

Liu, Y., Xiao, S., Yang, H., Lv, X., Hou, A., Ma, Y., Jiang, Y., Duan, C., Mi, W., Yang, J., Liu, D., Li, M., Zhang, J., Yang, Y., Diao, Y., Han, R., Song, S., Li, N., Yue, X., … Zhang, T. (2023). Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. The Lancet Regional Health - Western Pacific, 39. https://doi.org/10.1016/j.lanwpc.2023.100822

Ma, T. T., Wang, Y. H., Jiang, Y. F., Peng, C. Bin, Yan, C., Liu, Z. G., Xu, W. X., & Hanaoka, K. (2017). Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty: A meta-analysis. Medicine (United States), 96(25). https://doi.org/10.1097/MD.0000000000007190

Mazloomdoost, D., Pauls, R. N., Hennen, E. N., Yeung, J. Y., Smith, B. C., Kleeman, S. D., & Crisp, C. C. (2017). Liposomal bupivacaine decreases pain following retropubic sling placement: a randomized placebo-controlled trial. American Journal of Obstetrics and Gynecology, 217(5). https://doi.org/10.1016/j.ajog.2017.07.001

Meyer, L. A., Corzo, C., Iniesta, M. D., Munsell, M., Shi, Q., Pitcher, B., Lasala, J., Cain, K. E., Wang, X. S., Mena, G., & Ramirez, P. T. (2021). A prospective randomized trial comparing liposomal bupivacaine vs standard bupivacaine wound infiltration in open gynecologic surgery on an enhanced recovery pathway. American Journal of Obstetrics and Gynecology, 224(1). https://doi.org/10.1016/j.ajog.2020.07.017

Nguyen, A., Grape, S., Gobbetti, M., & Albrecht, E. (2023). 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. European Journal of Anaesthesiology, 40(9). https://doi.org/10.1097/EJA.0000000000001833

Okoroha, K. R., Lynch, J. R., Keller, R. A., Korona, J., Amato, C., Rill, B., Kolowich, P. A., & Muh, S. J. (2016). Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: a prospective randomized trial. Journal of Shoulder and Elbow Surgery, 25(11). https://doi.org/10.1016/j.jse.2016.05.007

Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2017). Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. National Academies Press.

Schroer, W. C., Diesfeld, P. G., LeMarr, A. R., Morton, D. J., & Reedy, M. E. (2015). Does Extended-Release Liposomal Bupivacaine Better Control Pain Than Bupivacaine After Total Knee Arthroplasty (TKA)? A Prospective, Randomized Clinical Trial. Journal of Arthroplasty, 30(9). https://doi.org/10.1016/j.arth.2015.01.059

Schwartz, G., Gadsden, J. C., Gonzales, J., Hutchins, J., Song, J., Brady, O. D., DiGiorgi, M., & Winston, R. (2024). A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. Journal of Clinical Anesthesia, 94. https://doi.org/10.1016/j.jclinane.2024.111402

Sethi, P. M., Brameier, D. T., Mandava, N. K., & Miller, S. R. (2019). Liposomal bupivacaine reduces opiate consumption after rotator cuff repair in a randomized controlled trial. Journal of Shoulder and Elbow Surgery, 28(5). https://doi.org/10.1016/j.jse.2019.01.008

Shih, E., DiMaio, J. M., Squiers, J. J., Wheeless, J., Hoffman, W. J., Banwait, J. K., Hamandi, M., Baxter, R., & Harrington, K. B. (2022). Effect of Preincisional Liposomal Bupivacaine Sternal Blockade on Poststernotomy Opioid Use. Annals of Thoracic Surgery, 114(5). https://doi.org/10.1016/j.athoracsur.2022.03.038

Solis-Pazmino, P., Figueroa, L., La, K., Termeie, O., Oka, K., Schleicher, M., Cohen, J., Barnajian, M., & Nasseri, Y. (2024). Liposomal bupivacaine versus conventional anesthetic or placebo for hemorrhoidectomy: a systematic review and meta-analysis. Techniques in Coloproctology, 28(1). https://doi.org/10.1007/s10151-023-02881-4

Vandepitte, C., Kuroda, M., Witvrouw, R., Anne, L., Bellemans, J., Corten, K., Vanelderen, P., Mesotten, D., Leunen, I., Heylen, M., Van Boxstael, S., Golebiewski, M., Van De Velde, M., Knezevic, N. N., & Hadzic, A. (2017). Addition of liposome bupivacaine to bupivacaine HCl versus bupivacaine HCl alone for interscalene brachial plexus block in patients having major shoulder surgery. Regional Anesthesia and Pain Medicine, 42(3). https://doi.org/10.1097/AAP.0000000000000560

Walker, E. M. K., Bell, M., Cook, T. M., Grocott, M. P. W., & Moonesinghe, S. R. (2016). Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study†. British Journal of Anaesthesia, 117(6). https://doi.org/10.1093/bja/aew381

Wang, X., Xiao, L., Wang, Z., Zhao, G., & Ma, J. (2017). Comparison of peri-articular liposomal bupivacaine and standard bupivacaine for postsurgical analgesia in total knee arthroplasty: A systematic review and meta-analysis. International Journal of Surgery, 39. https://doi.org/10.1016/j.ijsu.2017.02.011

Weiser, A. K., Jarzabkowski, P., & Laamanen, T. (2020). Completing the adaptive turn: An integrative view of strategy implementation. Academy of Management Annals, 14(2). https://doi.org/10.5465/annals.2018.0137

Yeap, Y. L., Wolfe, J., Stewart, J., McCutchan, A., Chawla, G., Robb, B., Holcomb, B., & Vickery, B. (2022). Liposomal bupivacaine addition versus standard bupivacaine alone for colorectal surgery: A randomized controlled trial. Pain Management, 12(1). https://doi.org/10.2217/pmt-2021-0033

Zhang, X., Yang, Q., & Zhang, Z. (2017). The efficiency and safety of local liposomal bupivacaine infiltration for pain control in total hip arthroplasty: A systematic review and meta-analysis. Medicine (United States), 96(49). https://doi.org/10.1097/MD.0000000000008433

Zhao, B., Ma, X., Zhang, J., Ma, J., & Cao, Q. (2019). The efficacy of local liposomal bupivacaine infiltration on pain and recovery after Total Joint Arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Medicine (United States), 98(3). https://doi.org/10.1097/MD.0000000000014092

Downloads

Published

2025-03-31

How to Cite

Da Silva, H. S., Gong, H., Wu, W., Fang, Z., & Mo, K. (2025). The Efficacy of Liposomal Bupivacaine in Managing Postoperative Pain, a Systematic Review and Meta-Analysis of Randomized Control Trials. Journal of World Science, 4(3), 344–356. https://doi.org/10.58344/jws.v4i3.1376