ReviewComparison of peri-articular liposomal bupivacaine and standard bupivacaine for postsurgical analgesia in total knee arthroplasty: A systematic review and meta-analysis

•To investigate the efficacy and safety between liposomal bupivacaine and standard bupivacaine in patients undergoing total knee arthroplasty.•Only high quality studies were selected.•Liposomal bupivacaine infiltration provides superior pain relief and less morphine consumption.

ObjectiveThis meta-analysis aimed to compare the efficacy and safety of intraoperative peri-articular liposomal bupivacaine and standard bupivacaine in patients undergoing total knee arthroplasty.MethodsA systematic search was performed in Medline (1966-2016.9), PubMed (1966-2016.9), Embase (1980-2016.9), ScienceDirect (1985-2016.9) and the Cochrane Library. Only high-quality studies were selected. Meta-analysis was performed using Stata 11.0 software.ResultsThree randomized controlled trials (RCTs) and two non-randomized controlled trials (Non-RCTs), including 1214 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) score at 24 h (SMD = −0.241, 95% CI: −0.374 to −0.108, P = 0.000), VAS score at 48 h (SMD = −0.124, 95% CI: −0.256 to 0.009, P = 0.0068), morphine equivalent consumption on POD 1 (SMD = −0.275, 95% CI: −0.398 to −0.153, P = 0.000) and incidence of nausea (RD = 0.038, 95% CI: 0.001 to 0.074, P = 0.042) and vomiting (RD = 0.38, 95% CI: 0.003 to 0.072, P = 0.032).ConclusionCompared to standard bupivacaine, intraoperative peri-articular liposomal bupivacaine infiltration promotes superior pain relief and less morphine consumption after total knee arthroplasty. In addition, there were fewer side effects associated with liposomal bupivacaine infiltration.