Intraoperative Liposomal Bupivacaine Does Not Reduce Opioid Use vs. Ropivacaine: A Systematic Review

Journal of Surgery 7 (1570) (2022)
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Introduction: Liposomal bupivacaine (LB) is a long-acting analgesic that, due to its liposomal formulation, purportedly extends its analgesic effect up to 72 hours. However, the clinical efficacy of LB appears mixed. This systematic review seeks to evaluate the effectiveness of liposomal bupivacaine in improving postoperative outcomes compared to ropivacaine (ROPI), another commonly used long-acting analgesic. Materials and Methods: Prospective and randomized controlled trials (RCTs) evaluating the efficacy of LB compared to ROPI were selected for review. Primary outcomes included hospital length of stay (LOS) and postoperative opioid consumption measured in oral morphine equivalents (OME). Secondary outcomes included analgesic cost. Results: 14 studies met the review criteria. We found that LB and ROPI are equivalent in managing postoperative pain. 8 of the 14 trials reported equal efficacy between LB and ROPI as determined by OME post-procedure and 10 of the 14 trials reported similar LOS after surgery. These findings remained consistent across multiple surgical procedures and multiple drug administrative modalities. Conclusion: Our systematic review found that LB was not superior to ROPI in reducing postoperative OME use and hospital LOS. The only consistent finding was the significantly increased cost of LB compared to that of ROPI. Therefore, the use of LB over ROPI cannot be justified.


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