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

Jian-Jiun Chen; Yun-Che Wu; Jun-Sing Wang; Cheng-Hung Lee

doi:10.1186/s13018-023-03699-4

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

J Orthop Surg Res. 2023 Mar 16;18(1):206. doi: 10.1186/s13018-023-03699-4.

Authors

Jian-Jiun Chen¹, Yun-Che Wu², Jun-Sing Wang^{3

4

5}, Cheng-Hung Lee^{6

7

8}

Affiliations

¹ Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan.
² Department of Orthopedics, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Boulevard, Taichung, 40705, Taiwan.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Boulevard, Taichung, 40705, Taiwan. jswang@vghtc.gov.tw.
⁴ Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan. jswang@vghtc.gov.tw.
⁵ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan. jswang@vghtc.gov.tw.
⁶ Department of Orthopedics, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Boulevard, Taichung, 40705, Taiwan. leechenghung0115@gmail.com.
⁷ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan. leechenghung0115@gmail.com.
⁸ Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan. leechenghung0115@gmail.com.

Abstract

Background: Liposomal bupivacaine (LB) is a relatively new formulation that slowly releases bupivacaine to extend its efficacy for 72-96 h. It is inconclusive whether LB offers better efficacy than traditional periarticular injection (TPAI) following total knee arthroplasty (TKA).

Methods: Relevant randomized controlled trials (RCTs) were searched using electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. Review Manager 5.4.1 was used for calculations.

Results: Sixteen RCTs were included in this meta-analysis. LB had better effects on morphine consumption equivalents during postoperative 24-48 h than TPAI. No significant difference was observed in pain relief, incidence of nausea and vomiting, or length of hospital stay between the two groups.

Conclusion: LB administration during TKA is not superior to TPAI. Studies with larger sample size are needed to validate our findings. PROSPERO registration number: CRD42022355094.

Keywords: Liposomal bupivacaine; Total knee arthroplasty; Traditional periarticular injection.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Analgesics, Opioid
Anesthetics, Local*
Arthroplasty, Replacement, Knee* / adverse effects
Bupivacaine
Humans
Liposomes
Pain, Postoperative / drug therapy
Pain, Postoperative / etiology
Randomized Controlled Trials as Topic

Substances

Anesthetics, Local
Liposomes
Bupivacaine
Analgesics, Opioid