The effect of liposomal bupivacaine for surgical wound infiltration: A meta‐analysis of randomised controlled trials

Abstract

Liposomal bupivacaine (LB) has consistently been considered a potential analgesic for surgical wound infiltration. However, the evidence of its analgesic effectiveness remains unclear. In this meta‐analysis, we attempted to identify the potential clinical role of LB wound infiltration in different surgical procedures. Randomised controlled trials (RCTs) comparing LB with non‐liposomal local anaesthetics and placebos were retrieved from six electronic databases. The primary outcome was cumulative morphine equivalent consumption within 24, 48, and 72 hours after surgery. Approximately 2659 patients from 22 studies were included in the meta‐analysis. Compared to the control, LB‐wound infiltration did not reduce the postoperative morphine consumption at 24 hours (weighted mean difference [WMD], −0.60 mg; 97.5% confidence interval [CI], −2.78 to 1.59 mg; P = 0.54), 48 hours (WMD, −1.00 mg; 97.5% CI, −3.23 to 1.24; P = 0.32) or 72 hours (WMD, 0.50 mg; 97.5% CI, −0.67 to 1.67; P = 0.33). Similarly, secondary outcome analysis did not reveal any additional benefits of LB in any other pain‐related outcomes. LB was not associated with any adverse effects. Overall, LB does not appear to improve the postoperative analgesic, rehabilitation, or safety outcomes. Current evidence does not support the routine use of LB for wound infiltration following surgical procedures.

Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers

“…[35][36][37][38] Liposomal bupivacaine, as investigated in the current study, was initially used for surgical infiltration with the main focus on postoperative pain therapy. [11][12][13]24,25,29 Only then was the spectrum of applications expanded to interscalene brachial plexus, 15,16 femoral nerve, 18,39 intercostal nerve, [19][20][21][22][23]40 and fascial plane block 41 techniques.…”

“…However, most of the available research has dealt with infiltration and fascial plane techniques, which cannot truly be considered regional anesthesia. 12,13,24,25 Those very few studies in the literature that do report on liposomal bupivacaine for peripheral nerve blockade have recently been subjected to meta-analysis, the results of which have engendered great controversy. 26 Despite a good base of citable reports, little is known about the pharmacodynamic characteristics of liposomal bupivacaine, considering that the available clinical studies almost invariably used postoperative opioid requirements as their primary outcome measure.…”

“…However, most of the available research has dealt with infiltration and fascial plane techniques, which cannot truly be considered regional anesthesia. 12,13,24,25 Those very few studies in the literature that do report on liposomal bupivacaine for peripheral nerve blockade have recently been subjected to meta-analysis, the results of which have engendered great controversy. 26…”

The effect of bupivacaine on analgesia and safety in patients undergoing hemorrhoidectomy: a meta-analysis

“…A meta-analysis is a powerful tool that can combine the results of two or more individual studies, demonstrates a good evidence advantage, and contributes to healthcare decision making ( Mohd-Ali and Chen, 2021 ; Ozek et al, 2021 ). Jiang et al (2023) conducted a meta-analysis and reported the effect of bupivacaine on the postoperative analgesic, rehabilitation, and safety outcomes for surgical wound infiltration. However, there is no meta-analysis reporting the analgesic effect and safety of bupivacaine in patients undergoing hemorrhoidectomy.…”