Liposomal bupivacaine for postoperative analgesia after thoracoscopic surgery: a systematic review and meta-analysis

Thoracoscopic surgery has become the standard approach for many thoracic conditions. Despite its advantages, postoperative pain remains a significant cause of complications. Liposomal bupivacaine (LB), an extended-release local analgesic, has been introduced to enhance recovery. This meta-analysis of randomized controlled trials (RCTs) compares the efficacy of LB vs. non-liposomal local anesthetics in patients undergoing thoracoscopic surgery.

We systematically searched PubMed, the Cochrane Library, Embase, and Web of Science for RCTs published from the inception of each database to November 2025. The risk of bias of the included studies was evaluated with the Cochrane Risk of Bias 1 (RoB 1) tool, and the quality of evidence was graded using the GRADE system. The primary outcome was postoperative opioid consumption at 24 hours, measured in morphine milligram equivalents (MMEs). Secondary outcomes included opioid consumption at 48 hours, 72 hours, and during total hospitalization; pain scores assessed using the visual analogue scale (VAS) at 24 hours, 48 hours, 72 hours, and over the entire hospitalization period; length of hospital stay (LOS); and time to first ambulation. Data were synthesized using Review Manager (RevMan; version 5.4).

Nine RCTs involving 915 patients were included. Compared to the control group, LB significantly reduced opioid consumption at 24 hours [mean difference (MD) =-1.83; 95% confidence interval (CI): -2.42, -1.24; P<0.001], 48 hours (MD =-2.22; 95% CI: -2.78, -1.66; P<0.001), and 72 hours (MD =-1.73; 95% CI: -2.21, -1.25; P<0.001). Pain scores were also significantly lower in the LB group at 24 hours (MD =-0.99; 95% CI: -1.57, -0.41; P<0.001) and 48 hours (MD =-0.42; 95% CI: -0.77, -0.06; P=0.02), but the difference was not statistically significant at 72 hours (MD =-0.41; 95% CI: -0.95, 0.13; P=0.14). No significant differences were found in total opioid consumption, pain scores over the entire hospitalization period, LOS, or time to first ambulation.

LB provides superior short-term analgesia but does not improve functional recovery outcomes compared to non-liposomal local anesthetics.