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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
  1. Hanns-Christian Dinges,
  2. Thomas Wiesmann,
  3. Berit Otremba,
  4. Hinnerk Wulf,
  5. Leopold H Eberhart and
  6. Ann-Kristin Schubert
  1. Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
  1. Correspondence to Dr Ann-Kristin Schubert, Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany; aschub{at}med.uni-marburg.de

Abstract

Background/Importance Liposomal 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.

Objective The 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 review Randomized 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.

Findings 23 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).

Conclusion The 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.

  • analgesia
  • nerve block
  • pain
  • postoperative
  • pain management
  • pharmacology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data are included in this review and/or supplements.

https://doi.org/10.1136/rapm-2020-102427

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data are included in this review and/or supplements.

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    Footnotes

    • Contributors A-KS: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, drafting the article, final approval of the version to be published, agreement to be accountable for all aspects of the work. H-CD: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, drafting the article, final approval of the version to be published, agreement to be accountable for all aspects of the work. BO: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, drafting the article, final approval of the version to be published, agreement to be accountable for all aspects of the work. TW: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, revising the article critically, final approval of the version to be published, agreement to be accountable for all aspects of the work. LE: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, revising the article critically, final approval of the version to be published, agreement to be accountable for all aspects of the work. HW: helped with substantial contributions to the conception and design of systematic review, data collection and acquisition, analysis and interpretation of data, revising the article critically, final approval of the version to be published, agreement to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests TW: receives consultancy fees from Teva Pharmaceuticals.; HW: receives speaker’s fees from B. Braun, Vygon and Sintetica

    • Provenance and peer review Not commissioned; externally peer reviewed.

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