Liposomal bupivacaine reduced postoperative analgesia in patients undergoing knee arthroplasty

Liposomal bupivacaine (LB), a sustained-release formulation, is designed to prolong regional analgesia, and has been investigated as a solution for perioperative pain management. This meta-analysis of randomized controlled trials (RCTs) assessed the benefits of LB in patients undergoing knee arthroplasty.

Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were accessed and explored until November 2025. The extracted data consisted of the risk of nausea/vomiting (N/V), length of stay (LOS), and postoperative pain and opioid consumption at 1, 2, and 3 days postoperatively.

Six RCTs were included, consisting of 311 in the LB group and 318 in the control group. There was no difference between the two groups in N/V or LOS. However, patients receiving LB had less pain compared with patients receiving ropivacaine at 1 day postoperatively (standardized mean difference = -0.69, P = 0.03), and less pain compared with the control groups as a whole 2 days postoperatively (standardized mean difference = -0.44, P < 0.001). Opioid consumption was lower in the LB group compared with the group receiving standard bupivacaine at 1, 2, and 3 days postoperatively (mean difference = -11.52 morphine milligram equivalents (MME), mean difference = -9.02 MME, mean difference = -4.58 MME, P < 0.001 respectively). Similarly, Opioid consumption was lower in the LB group compared with the control group as a whole at 2 and 3 days postoperatively (mean difference = -7.01 MME, P = 0.02; mean difference = -4.59 MME, P < 0.001, respectively).

LB reduces postoperative pain and opioid consumption after knee arthroplasty with no increased risk of N/V.