Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective. To conduct the first-ever meta-analysis of all randomized controlled trials (RCTs) that scrutinized the analgesic efficacy of liposomal bupivacaine (LB, intervention) versus nonliposomal local anesthetic agents (NLAAs, control) during arthroscopic rotator cuff repair (ARCR). Methods. Five databases were screened from inception until 09-April-2022. Subgroup analyses according to the postoperative day (POD, POD 0-7) were conducted. The data were summarized as weighted mean difference (WMD) with 95% confidence interval (CI) under the random-effects model. Results. Seven RCTs comprising 442 patients were included. Three, three, and one RCT(s) were judged to have an overall "low", "high", and "unclear" risk of bias, respectively. Regarding overall VAS pain score, there was no significant difference between both groups (WMD = -0.56, 95% CI [-1.16, 0.04], p = 0.07). Subgroup analyses showed significantly reduced postoperative VAS pain scores in favor of the LB group on POD 1/2; however, these reductions were not clinically meaningful. Also, LB correlated with a significant reduction in overall postoperative opioid consumption (WMD = -7.72 MME, 95% CI [-11.48, -3.97], p < 0.001). Subgroup analyses showed a significantly reduced postoperative opioid consumption in favor of the LB group on POD 1/2/3; however, these reductions were not clinically meaningful. Conclusions. Among patients undergoing ARCR, this systematic review and meta-analysis of RCTs showed that LB did not correlate with clinically meaningful reductions in postoperative VAS pain scores and overall opioid consumption. Future large-sized and well-designed RCTs are needed to consolidate the presented evidence.