Liposome bupivacaine for pain control after total knee arthroplasty: a meta-analysis

BACKGROUND: Total knee arthroplasty (TKA) is associated with intense and long-duration pain. Research is currently being conducted on the use of liposome bupivacaine (LB) to prolong the effects of local infiltration anesthesia. This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy and safety of pain control of using LB versus placebo after TKA. METHODS: In April 2016, the Medline, Embase, PubMed, Cochrane Controlled Trials Register (CENTRAL), Web of Science, Google database, and Chinese Wanfang databases were searched to identify articles that compare a LB group versus a control group for pain control after TKA. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the visual analogue scale (VAS) score after TKA at 24, 48, and 72 h. The second outcome was nausea complications, which represent morphine-related side effects. Stata 12.0 software was used for the meta-analysis. RESULTS: Five studies involving 574 patients met the inclusion criteria. The meta-analysis revealed that LB can decrease the VAS score at 24 h (mean difference (MD) = −0.50; 95 % CI −0.97 to −0.04; P = 0.034), 48 h (MD = −0.26; 95 % CI −0.71 to 0.19; P = 0.256), and 72 h (MD = −0.26; 95 % CI −0.71 to 0.19; P = 0.256). There was no significant difference with respect to the length of hospital stay (MD = −0.08; 95 % CI −0.28 to 0.13; P = 0.475). Furthermore, LB can reduce the occurrence of nausea (RR = 0.38; 95 % CI 0.18 to 0.79; P = 0.009). CONCLUSIONS: Based on the current meta-analysis, LB as a novel anesthetic formulation administration following TKA demonstrated better pain control; however, the sample size was limited, and further RCTs are needed to identify the effects of LB after TKA.