A Meta-Analysis Comparing Liposomal Bupivacaine and Traditional Periarticular Injection for Pain Control after Total Knee Arthroplasty

Abstract

Liposomal bupivacaine is a novel method for pain control after total knee arthroplasty (TKA), but recent studies showed no advantage for patients undergoing TKA compared with traditional periarticular injection (PAI). The purpose of this analysis was to compare the clinical outcomes between liposomal bupivacaine treatment and traditional PAI. We retrospectively reviewed data from 16 clinical trials in published databases from their inception to June 2017. The primary outcome was postoperative Visual Analogue Scale (VAS) score and secondary outcomes included opiate usage, narcotic consumption, range of motion, and length of stay. Nine randomized controlled trials and seven nonrandomized controlled trials involving 924 liposomal bupivacaine cases and 1,293 traditional PAI cases were eligible for inclusion in the meta-analysis. No differences were detected in most of the clinical outcomes, except for postoperative VAS within 12 hours and length of stay. This analysis showed that liposomal bupivacaine is not associated with significant improvement in postoperative pain control or other outcomes in TKA compared with PAI.

The efficacy of liposomal bupivacaine compared with traditional peri-articular injection for pain control following total knee arthroplasty: an updated meta-analysis of randomized controlled trials

“…Bagsby et al [37] perform a retrospective cohort study and concluded that “liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control programme in patients undergoing TKA”. Interestingly, the efficacy of liposomal bupivacaine was better in the meta-analysis performed by Wang et al [9], similar in the meta-analysis conducted by Kuang et al [10], and worse in the meta-analysis performed by Sun et al [11]. Obviously, the comparison has not reached a unified recommendation.…”

“…Liposomal bupivacaine is an updated medication from bupivacaine, which is scraped from liposomes and injected into surgical site to alleviate postoperative pain. Since the drug was approved by the FDA in 2013, a series of clinical trials [35–37] and meta-analysis [9–11] have compared the efficacy of liposomal bupivacaine with traditional peri-articular injection (TPAI) following total joint arthroplasty (TJA). Lonner et al [35] concluded that it is an “effective mechanism to assist in early hospital discharge and rapid recovery after TJA.” Barrington et al [36] conduct a clinical trial with more than 1000 patients and demonstrated that LB showed superiority in lower pain scores and reduced length of hospital stay.…”

“…Kuang et al [10] conduct a meta-analysis with 4 RCTs and 7 non-RCTs comparing the LB with traditional peri-articular injection after TKA, but the number of RCTs are limited. Sun et al [11] perform a meta-analysis with 9 RCTs and 7 non-RCTs comparing the LB with traditional peri-articular injection after TKA. The inclusion of non-RCTs is unnecessary when the number of RCTs is sufficient.…”

Cyclin D1 regulates osteoarthritis chondrocyte apoptosis via WNT3/β-catenin signalling

“…At the end stage of OA, total joint arthroplasty was the final choice [15,16]. Total joint arthroplasty was always associated with an increase in economic costs [17]. Preventing OA progress could relieve knee pain and decrease relevant costs.…”

Comprehensive Comparison of Liposomal Bupivacaine with Femoral Nerve Block for Pain Control Following Total Knee Arthroplasty: An Updated Systematic Review and Meta‐Analysis

“…Up to now, there have been eight meta‐analyses comparing the above three types of analgesic methods. Two of them compare the efficacy of LB with FNB following TKA.…”