Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty: A meta-analysis

Ting-Ting Ma, Yu-Hui Wang, Yun-Feng Jiang, Cong-Bin Peng, Chao Yan, Zi-Gui Liu, Wei-Xing Xu, Ting-Ting Ma, Yu-Hui Wang, Yun-Feng Jiang, Cong-Bin Peng, Chao Yan, Zi-Gui Liu, Wei-Xing Xu

Abstract

Background: In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA.

Methods: We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model.

Results: Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P = .018) and the length of hospital stay (P = .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05).

Conclusion: Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of study search and inclusion criteria.
Figure 2
Figure 2
Risk of bias of included randomized controlled trials. +, no bias; −, bias; ?, bias unknown.
Figure 3
Figure 3
Risk of bias graph of the randomized controlled trials.
Figure 4
Figure 4
Forest plots of VAS at 24 hours between liposomal bupivacaine and traditional bupivacaine. VAS  =  visual analog scale.
Figure 5
Figure 5
Forest plots of VAS at 48 hours between liposomal bupivacaine and traditional bupivacaine. VAS  =  visual analog scale.
Figure 6
Figure 6
Forest plots of VAS at 72 hours between liposomal bupivacaine and traditional bupivacaine. VAS  =  visual analog scale.
Figure 7
Figure 7
Forest plots of total morphine consumption at 24 hours between liposomal bupivacaine and traditional bupivacaine. VAS  =  visual analog scale.
Figure 8
Figure 8
Forest plots of the length of hospital stay between liposomal bupivacaine and traditional bupivacaine.
Figure 9
Figure 9
Sensitivity analysis of the included studies for VAS at 24 hours (A) and the length of hospital stay (B). VAS  =  visual analog scale.

References

    1. Harvey NR, Wolf BJ, Bolin ED, et al. Comparison of analgaesia with lumbar epidurals and lumbar plexus nerve blocks in patients receiving multimodal analgaesics following primary total hip arthroplasty: a retrospective analysis. Int Orthop 2017;Epub ahead of print.
    1. Li F, Ma J, Kuang M, et al. The efficacy of pregabalin for the management of postoperative pain in primary total knee and hip arthroplasty: a meta-analysis. J Orthop Surg Res 2017;12:49.
    1. Yu SW, Szulc AL, Walton SL, et al. Liposomal bupivacaine as an adjunct to postoperative pain control in total hip arthroplasty. J Arthroplasty 2016;31:1510–5.
    1. Hojer Karlsen AP, Geisler A, Petersen PL, et al. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain 2015;156:8–30.
    1. Pagnano MW, Hebl J, Horlocker T. Assuring a painless total hip arthroplasty: a multimodal approach emphasizing peripheral nerve blocks. J Arthroplasty 2006;21(4 suppl 1):80–4.
    1. Jimenez-Almonte JH, Wyles CC, Wyles SP, et al. Is Local infiltration analgesia superior to peripheral nerve blockade for pain management after THA: a network meta-analysis. Clin Orthop Rel Res 2016;474:495–516.
    1. Yan H, Cang J, Xue Z, et al. Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: a systematic review and meta-analysis. Bosnian J Basic Med Sci 2016;16:239–46.
    1. Andersen LO, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. British J Anaesth 2014;113:360–74.
    1. Golembiewski J, Dasta J. Evolving role of local anesthetics in managing postsurgical analgesia. Clin Ther 2015;37:1354–71.
    1. Joshi GP, Beck DE, Emerson RH, et al. Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural Surgical Pain Congress. Am Surg 2014;80:219–28.
    1. Parascandola SA, Ibanez J, Keir G, et al. Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection dagger. Interact Cardiovasc Thorac Surg 2017.
    1. Singh PM, Borle A, Trikha A, et al. Role of periarticular liposomal bupivacaine infiltration in patients undergoing total knee arthroplasty—a meta-analysis of comparative trials. J Arthroplasty 2017;32:675–88. e671.
    1. Beachler JA, Kopolovich DM, Tubb CC, et al. Liposomal bupivacaine in total hip arthroplasty: do the results justify the cost? J Orthop 2017;14:161–5.
    1. Higgins JPT GS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at: Accessed 2011.
    1. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical Res Ed) 2009;339:b2700.
    1. GS HJ. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available at: Accessed 2011.
    1. Wells GA, Shea BJ, O’Connell D, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agriculture 2014;18:727–34.
    1. Cherian JJ, Barrington J, Elmallah RK, et al. Liposomal bupivacaine suspension, can reduce length of stay and improve discharge status of patients undergoing total hip arthroplasty. Surg Technol Int 2015;27:235–9.
    1. Domb BG, Gupta A, Hammarstedt JE, et al. The effect of liposomal bupivacaine injection during total hip arthroplasty: a controlled cohort study. BMC Musculoskel Disord 2014;15:310.
    1. Emerson RH, Barrington JW, Olugbode O, et al. Comparison of local infiltration analgesia to bupivacaine wound infiltration as part of a multimodal pain program in total hip replacement. J Surg Orthop Adv 2015;24:235–41.
    1. Asche CV, Ren J, Kim M, et al. Local infiltration for postsurgical analgesia following total hip arthroplasty: a comparison of liposomal bupivacaine to traditional bupivacaine. Curr Med Res Opin 2017;33:1–8.
    1. Wu ZQ, Min JK, Wang D, et al. Liposome bupivacaine for pain control after total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2016;11:84.
    1. Wang X, Xiao L, Wang Z, et al. Comparison of peri-articular liposomal bupivacaine and standard bupivacaine for postsurgical analgesia in total knee arthroplasty: a systematic review and meta-analysis. Int J Surg (London, England) 2017;39:238–48.
    1. Hamilton TW, Athanassoglou V, Mellon S, et al. Liposomal bupivacaine infiltration at the surgical site for the management of postoperative pain. Cochrane Database Syst Rev 2017;2:Cd011419.
    1. Liu SQ, Chen X, Yu CC, et al. Comparison of periarticular anesthesia with liposomal bupivacaine with femoral nerve block for pain control after total knee arthroplasty: a PRISMA-compliant meta-analysis. Medicine 2017;96:e6462.
    1. Kuang MJ, Du Y, Ma JX, et al. The efficacy of liposomal bupivacaine using periarticular injection in total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2017;32:1395–402.

Source: PubMed

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