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Background and Aims Mastectomy and mammoplasty are common procedures associated with moderate to severe pain in the postoperative period, often requiring opioids for pain management. The use of regional anesthesia, such as local infiltration of liposomal bupivacaine, has been shown to decrease opioid consumption and pain scores. Local infiltration, a traditional method of anesthesia, is practical and can save time in the operating room. This systematic review explores local infiltration of liposomal bupivacaine versus bupivacaine in this population.
Methods We searched Medline, Cochrane Library, Embase, ClinicalTrials.gov, and the reference list of articles included for randomized and non-randomized studies of 18 years old or older patients undergoing mastectomy or mammaplasty. No other regional anesthesia techniques besides local infiltration were included. Two independent authors appraised the literature.Registered under PROSPERO CRD42023415443.
Results Liposomal bupivacaine seems to be beneficial during the first 24 hours considering the length of hospital stay and opioid rescue medication. The way pain scores are reported varied among studies and different time assessments were used. The majority of studies reported lower pain scores with liposomal bupivacaine during the first 24h.
Conclusions Our findings suggest that the use of liposomal bupivacaine for local infiltration demonstrates a promising trend towards efficacy, with the potential to decrease both inpatient opioid consumption and antiemetic use following breast surgery.Due to the heterogeneous outcome data captured on pain scores, it is difficult to determine its real impact. We urge societies to support standardized ways to evaluate pain and other outcomes of interest for regional anesthesia.