Anesthesiology. 2021 Feb 1;134(2):147-164. doi: 10.1097/ALN.0000000000003651.
Liposomal bupivacaine is purported to extend analgesia of peripheral nerve blocks when administered perineurally. However, evidence of the clinical effectiveness of perineural liposomal bupivacaine is mixed. This meta-analysis seeks to evaluate the effectiveness of perineural liposomal bupivacaine in improving peripheral nerve block analgesia as compared with nonliposomal local anesthetics.
The authors identified randomized trials evaluating the effectiveness of peripheral nerve block analgesic that compared liposomal bupivacaine with nonliposomal local anesthetics. The primary outcome was the difference in area under the receiver operating characteristics curve (AUC) of the pooled 24- to 72-h rest pain severity scores. Secondary outcomes included postoperative analgesic consumption, time to first analgesic request, incidence of opioid-related side effects, patient satisfaction, length of hospital stay, liposomal bupivacaine side effects, and functional recovery. AUC pain scores were interpreted in light of a minimal clinically important difference of 2.0 cm · h.
Nine trials (619 patients) were analyzed. When all trials were pooled, AUC pain scores ± SD at 24 to 72 h were 7.6 ± 4.9 cm · h and 6.6 ± 4.6 cm · h for nonliposomal and liposomal bupivacaine, respectively. As such, perineural liposomal bupivacaine provided a clinically unimportant benefit by improving the AUC (95% CI) of 24- to 72-h pain scores by 1.0 cm · h (0.5 to 1.6; P = 0.003) compared with nonliposomal bupivacaine. Excluding an industry-sponsored trial rendered the difference between the groups nonsignificant (0.7 cm · h [-0.1 to 1.5]; P = 0.100). Secondary outcome analysis did not uncover any additional benefits to liposomal bupivacaine in pain severity at individual timepoints up to 72 h, analgesic consumption, time to first analgesic request, opioid-related side effects, patient satisfaction, length of hospital stay, and functional recovery. No liposomal bupivacaine side effects were reported.
Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks.
脂质体布比卡因据称在神经周围给药时可延长周围神经阻滞的镇痛作用。然而，神经周围脂质体布比卡因的临床效果证据不一。本荟萃分析旨在评估与非脂质体局部麻醉剂相比，神经周围脂质体布比卡因在改善周围神经阻滞镇痛方面的效果。
作者确定了评估比较脂质体布比卡因与非脂质体局部麻醉剂的周围神经阻滞镇痛效果的随机试验。主要结局是汇总 24-72 小时静息痛严重程度评分的受试者工作特征曲线（ROC）下面积（AUC）的差异。次要结局包括术后镇痛消耗、首次镇痛请求时间、阿片类相关副作用发生率、患者满意度、住院时间、脂质体布比卡因副作用和功能恢复。AUC 疼痛评分根据 2.0cm·h 的最小临床重要差异进行解释。
共分析了 9 项试验（619 例患者）。当所有试验合并时，24-72 小时时非脂质体和脂质体布比卡因的 AUC 疼痛评分±SD 分别为 7.6±4.9cm·h 和 6.6±4.6cm·h。因此，与非脂质体布比卡因相比，神经周围脂质体布比卡因使 24-72 小时疼痛评分 AUC（95%CI）提高了 1.0cm·h（0.5 至 1.6；P=0.003），这提供了一个临床上不重要的益处。排除一项由行业资助的试验后，两组间的差异无统计学意义（0.7cm·h[-0.1 至 1.5]；P=0.100）。对疼痛严重程度的个体时间点（高达 72 小时）、镇痛消耗、首次镇痛请求时间、阿片类相关副作用、患者满意度、住院时间和功能恢复的二次结局分析并未发现脂质体布比卡因的任何额外益处。未报告脂质体布比卡因的副作用。
与普通局部麻醉剂相比，神经周围脂质体布比卡因在术后疼痛评分 AUC 方面提供了统计学上显著但临床上不重要的改善。此外，在排除一项由行业资助的试验后，该获益变得无统计学意义，且脂质体布比卡因在术后疼痛和所有其他镇痛和功能结局方面与普通局部麻醉剂无差异。高质量证据不支持将神经周围脂质体布比卡因用于外周神经阻滞，而不是非脂质体布比卡因。
