Liposomal versus standard bupivacaine for post-operative opioid requirements following abdominal-based breast reconstruction: A systematic review and meta-analysis

TL;DR

This study compares liposomal and standard bupivacaine for pain management after breast reconstruction, finding no significant difference in opioid use or recovery time.

Contribution

A systematic review and meta-analysis evaluating the clinical benefits of liposomal bupivacaine in post-operative care for breast reconstruction.

Findings

Liposomal bupivacaine showed a trend toward reduced opioid use and shorter hospital stays, but results were not statistically significant.

Pooled data indicated inpatient opioid use of 132.61 OME and an average hospital stay of 3.39 days with liposomal bupivacaine.

Complication rates like seroma and flap loss were reported at 8% and 1.08%, respectively.

Abstract

Donor-site pain after abdominal-based autologous breast reconstruction affects opioid use and recovery. Liposomal bupivacaine (LB) delivered via the transversus abdominis plane (TAP) block may enhance analgesia compared with standard bupivacaine (SB), yet its added clinical benefit remains unclear.

A systematic review and meta-analysis was conducted according to PRISMA 2020 and Cochrane guidelines. Databases searched included PubMed, Embase, and Cochrane Library. Studies comparing LB with SB for the TAP block were included. Outcomes included postoperative opioid consumption, pain scores, hospital length of stay (LOS), time to ambulation, and complications. Both pairwise and single-arm meta-analyses were performed using a random-effects model.

A total of twelve studies were included in the analysis, comprising 1,690 participants. Pairwise meta-analyses indicated a trend favoring the use of LB in relation to total opioid use (SMD, –0.17; 95% CI [–1.20, 0.86]; p = 0.75) and LOS (SMD, –0.83 days; 95% CI [–1.76, 0.09]; p = 0.08). However, neither finding was statistically significant. In single-arm analyses, the pooled inpatient opioid use with LB was 132.61 oral morphine equivalents (OME), with post-anesthesia care unit (PACU) use at 17.56 OME and an average LOS of 3.39 days. The pooled rates of seroma and flap loss were 8% and 1.08%, respectively. Additionally, cost and ambulation outcomes varied across the studies.

Liposomal bupivacaine appears safe and may offer modest recovery benefits in abdominal-based breast reconstruction. However, its incremental advantage over standard bupivacaine remains uncertain in ERAS-optimized settings. Selective use is recommended pending further high-quality trials.

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