Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Shankar Raman, Mayin Lin, Nivedita Krishnan, Shankar Raman, Mayin Lin, Nivedita Krishnan

Abstract

Objective: The objective of the study was to systematically investigate the outcomes of Liposomal Bupivacaine following major colorectal resections. Patients and methods: We conducted a comprehensive literature search of PubMed, Medline, Google scholar, Cochrane Central Registry and clinical trials.gov databases through May 2017 for studies published regarding liposomal bupivacaine. Studies were filtered based on relevance to perioperative analgesia in colorectal resections. Data comparing type of study, techniques of resection, mode of administration of liposomal bupivacaine, details of control group, outcomes were collected. Results: A total of 1008 patients from seven studies were included in this systematic review and meta-analysis. The studies were mostly retrospective or prospective cohort studies with one randomized controlled trial (RCT). Meta-analysis showed that liposomal bupivacaine was associated with decreased length of stay, standard mean difference in days (SMD) - 0.34, (95% confidence intervals [CI] - 0.56, -0.13, p = .001) and decreased IV opioid use (expressed as intravenous morphine equivalent in milligrams) in the first 48-72 h, SMD -0.49 (95% CI -0.69, -0.28, p < .00001). Pain scores were also significantly low in patients who received liposomal bupivacaine, SMD -0.56 (95% CI -1.07, -0.06, p = .03]. There was no significant difference in hospitalization costs between the two groups. Conclusions: Use of liposomal bupivacaine is associated with decreased IV opioid use, length of stay and lower pain scores. However, our data needs to be interpreted cautiously given the relative paucity of randomized controlled trials.

Keywords: Liposomal bupivacaine; colectomy; colon resection; colorectal surgery.

Figures

Figure 1.
Figure 1.
Flow diagram showing article selection process.
Figure 2.
Figure 2.
Forest plot showing the individual and pooled estimate of length of stay in patients receiving liposomal bupivacaine vs. controls.
Figure 3.
Figure 3.
Forest plot showing the individual and pooled estimate of IV opioid used in patients receiving liposomal bupivacaine versus controls.
Figure 4.
Figure 4.
Forest plot showing the individual and pooled estimate of pain score in patients receiving liposomal bupivacaine versus controls.
Figure 5.
Figure 5.
Forest plot showing the individual and pooled estimate of hospitalization costs in patients receiving liposomal bupivacaine versus controls.

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