Anesthesiology. 2021 Feb 1;134(2):283-344. doi: 10.1097/ALN.0000000000003630.
The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, USA) to control postoperative pain that are currently published. When infiltrated surgically and compared with unencapsulated bupivacaine or ropivacaine, only 11% of trials (4 of 36) reported a clinically relevant and statistically significant improvement in the primary outcome favoring liposomal bupivacaine. Ninety-two percent of trials (11 of 12) suggested a peripheral nerve block with unencapsulated bupivacaine provides superior analgesia to infiltrated liposomal bupivacaine. Results were mixed for the 16 trials comparing liposomal and unencapsulated bupivacaine, both within peripheral nerve blocks. Overall, of the trials deemed at high risk for bias, 84% (16 of 19) reported statistically significant differences for their primary outcome measure(s) compared with only 14% (4 of 28) of those with a low risk of bias. The preponderance of evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics.
作者对目前已发表的所有涉及临床应用脂质体布比卡因（Exparel；Pacira Pharmaceuticals，美国）控制术后疼痛的随机对照试验（n = 76）进行了全面总结。当手术浸润时，与未包裹的布比卡因或罗哌卡因相比，只有 11%的试验（4/36）报告了主要结局有临床相关且具有统计学意义的改善，有利于脂质体布比卡因。92%的试验（11/12）表明，未包裹的布比卡因的外周神经阻滞提供了优于浸润性脂质体布比卡因的镇痛效果。对于比较脂质体和未包裹布比卡因的 16 项试验，结果喜忧参半，无论是在周围神经阻滞中。总体而言，在被认为存在高偏倚风险的试验中，84%（16/19）报告其主要结局测量指标存在统计学显著差异，而低偏倚风险的试验中只有 14%（4/28）报告存在统计学显著差异。绝大多数证据都不支持常规使用脂质体布比卡因替代标准局部麻醉剂。
