RESUMEN
BACKGROUND: Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72âh postoperatively. OBJECTIVES: To compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks. DESIGN: A systematic review and meta-analysis with trial sequential analysis. DATA SOURCES: MEDLINE, Embase and Web of Science, among others, up to June 2022. ELIGIBILITY CRITERIA: We retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24âh. Secondary endpoints included rest pain score at 48 and 72âh, and morphine consumption at 24, 48 and 72âh. RESULTS: Twenty-seven trials including 2122 patients were identified. Rest pain scores at 24âh were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I2 â=â87%, P â<â0.001. This reduction in pain scores persisted at 48âh and 72âh with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I2 â=â82%, P â=â0.001 and -0.7 (-1.1 to -0.3), I2 â=â80%, P â<â0.001, respectively. There were no differences in interval morphine consumption at 24âh ( P â=â0.15), 48âh ( P â=â0.15) and 72âh ( P â=â0.07). The quality of evidence was moderate. CONCLUSIONS: There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.