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

Abstract

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

Interscalene Brachial Plexus Block with Liposomal Bupivacaine versus Standard Bupivacaine with Perineural Dexamethasone: A Noninferiority Trial

“…These findings are similar to what was found in three recent reviews and meta-analyses 28–30 on comparing perineural liposomal bupivacaine to standard bupivacaine. All three reviews found that perineural liposomal bupivacaine was associated with statistically but not clinically meaningful differences in pain scores compared with standard bupivacaine.…”

“…We designed our study to compare perineural liposomal bupivacaine to the adjuvant perineural dexamethasone for use in interscalene nerve blocks and for clinical relevance. Because there have been multiple published studies comparing liposomal bupivacaine to plain bupivacaine [28][29][30] but none to plain bupivacaine with dexamethasone, we felt that a randomized controlled trial comparing perineural liposomal bupivacaine to plain bupivacaine with the adjuvant perineural dexamethasone for interscalene nerve blocks would be clinically relevant for many practitioners. The perineural analgesic efficacy of dexamethasone has already been noted previously, and a survey sent to all members of the Society for Ambulatory Anesthesia (SAMBA; Milwaukee, Wisconsin) noted that for patients receiving nerve block, 85% of respondents discharged patients with long-acting blocks.…”

Novel Local Anesthetics in Clinical Practice: Pharmacologic Considerations and Potential Roles for the Future

“…The active component bupivacaine 12% is an experimental pain-relieving medication, and is in the form of a capsule in a biological degradable structure. It is designed for surgical infiltration to achieve a long-term post-operative analgesia, reduce opioid consumption and improve post-surgical recovery (47). Bupivacaine is slowly released over several days following injection.…”

Liposomal bupivacaine versus bupivacaine hydrochloride: are we changing the outcomes?

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Hanns-Christian et al 1 conducted a literature review with the objective of determining whether there is a difference in postoperative pain scores and opioid consumption between patients who received liposomal bupivacaine and patients who received bupivacaine hydrochloride.The authors concluded that the beneficial effect on both postoperative pain scores and opioid consumption was small but not clinically relevant. 1

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“…The authors concluded that the beneficial effect on both postoperative pain scores and opioid consumption was small but not clinically relevant. 1…”