Liposomal Bupivacaine Research Articles

Thoracic paravertebral block (TPVB) with liposomal bupivacaine (LB) is increasingly used for postoperative pain control in patients undergoing thoracic surgery, but relevant data are scarce, and there are few data on LB-TPVB combined with drainage tube patient-controlled analgesia (PCA). The aim of this study is to explore the effect of LB-TPVB combined with drainage-tube PCA on postoperative pain after thoracoscopic lobectomy. This is a prospective, multicentre, double-blind, randomized controlled study. Participants will be randomly assigned to the standard bupivacaine (SB) group, SB + drainage-tube PCA (DTA) group, LB group, or LB + DTA group. The primary outcome is the 72-h mean Numerical Rating Scale (NRS) pain score at rest. The target sample size is 228 patients, with 57 patients in each group. Our study hypothesizes that preoperative ultrasound-guided thoracic nerve block combined with drainage tube self-controlled analgesia is more effective in reducing postoperative pain following thoracoscopic lobe resection compared to thoracic nerve block alone. Additionally, liposomal bupivacaine was found to be more effective than standard bupivacaine in this context. These results will have implications for improving postoperative analgesia protocols for patients undergoing thoracoscopic lung surgery. ClinicalTrials.gov, NCT06165991. Registered 29 November 2023, https://clinicaltrials.gov/study/NCT06165991 .

Pain management remains a major clinical challenge, as conventional opioids and local anesthetics suffer from short analgesic duration, systemic toxicity, and dependence risks. Advanced drug delivery systems, particularly hydrogels and liposomal bupivacaine, have emerged as promising solutions to address these limitations. Hydrogels, composed of cross-linked hydrophilic polymer networks, enable biocompatible, biodegradable, and sustained drug release, while liposomal bupivacaine encapsulates the anesthetic within lipid vesicles to prolong local analgesia and minimize systemic toxicity. The combination of these systems offers synergistic benefits, including extended drug retention, enhanced efficacy, and reduced opioid reliance. However, clinical translation remains constrained by formulation instability, high production costs, variable patient responses, and stringent regulatory requirements. This review provides a comprehensive overview of current advances in hydrogel and liposomal bupivacaine technologies, highlighting their clinical potential, ongoing challenges, and future directions toward safer, more effective, and personalized pain management strategies.

Bridging Disciplines: A Commentary on the Phase 3 Trial of Liposomal Bupivacaine via Adductor Canal Block for Total Knee Arthroplasty.

Commentary on "A Phase 3 Active-Controlled Trial of Liposomal Bupivacaine via Adductor Canal Block for Total Knee Arthroplasty".

Comparison of 4 local anesthetic techniques for open radical cystectomy: A prospective, randomized controlled trial.

Retrospective Cohort Study. This study aimed to compare perioperative pain outcomes in Adolescent Idiopathic Scoliosis (AIS) patients who either did or did not receive a liposomal bupivacaine (LB) injection during their posterior spinal fusion (PSF). Liposomal bupivacaine (LB) has been promoted for its apparent long-lasting effects on pain management when compared to standard formulations. Many studies in adult spine populations have been carried out with varying results but few studies have investigated LB's effect in the pediatric population. 472 pediatric patients with spine deformity undergoing posterior spinal fusion (PSF) between 2018-2024 were included. Starting early 2018, patients began receiving peri-incisional injections of LB by plastic surgeons during PSF closure (LB Group). These patients were compared to those that did not receive any injections (Non-LB [N-LB] Group). Pain scores, opioid consumption (MME), time to ambulation (out-of-bed/OOB), length of stay (LOS), narcotic refills, and 90- day complications were analyzed. Differences between the LB and N-LB groups were assessed using the Wilcoxon rank-sum test for continuous variables and either the chi-square test or Fisher's exact test for categorical variables, as appropriate. A non-parametric analysis of covariance (ANCOVA) was conducted to compare pain scores at rest on POD1 and POD2, as well as morphine consumption during the first 24 hours and total morphine consumption. 295 patients were in the LB Group, and 177 patients were N-LB. No differences were noted in demographics. Pain scores at rest were significantly lower on POD 1, POD 2, and overall (P<0.05) in LB patients. LOS was significantly shorter in LB patients (P<0.001). Significantly more patients were out of bed by POD 0 (59.9% vs. 38.0%, P<0.001) in the LB group. LB patients consumed significantly less opioids in 0-24 hours postop and during their total hospital stay (P<0.001 and P=0.032, respectively). Patients who received liposomal bupivacaine had lower VAS pain scores at rest, opioid consumption, and length of stay with no increase in complications. This suggests that a long-acting local anesthetic formulation may offer superior pain management.

Background/Objectives: Abdominal aortic aneurysms (AAAs) are exceedingly rare in pediatric patients but carry a significant risk of rupture, necessitating urgent surgical repair. Postoperative pain management following open AAA repair is particularly challenging and ultrasound-guided rectus sheath blocks (RSBs) offer a targeted and lower-risk alternative for midline abdominal incisions. Methods: We present an 8-year-old male who underwent open infrarenal AAA repair. Multilevel bilateral ultrasound-guided RSBs were performed at T7, the umbilicus and T12 using a mixture of liposomal bupivacaine, bupivacaine, and dexamethasone preservative free (PF). Results: Postoperative pain scores remained consistently low through postoperative day (POD) 6, with minimal opioid requirements. Functional recovery was rapid, with sitting achieved by POD 1 and ambulation by POD 2. Plasma bupivacaine concentrations remained within safe limits throughout hospitalization. Conclusions: Multilevel bilateral RSBs with liposomal bupivacaine, bupivacaine, and dexamethasone PF provided prolonged opioid-sparing analgesia, facilitated early mobilization, and supported enhanced recovery in this complex pediatric surgical case.

Hallux valgus repair surgery is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and update previous PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations for optimal pain management after hallux valgus repair surgery. A systematic review utilising PROSPECT methodology was performed. Randomised controlled trials and systematic reviews published in the English language from January 1, 2019 to November 19, 2024 that assessed postoperative pain using analgesic, anaesthetic and surgical interventions were identified from CENTRAL, CINAHL, EMBASE, MEDLINE and Web of Science. Of the 375 articles identified, 17 RCTs and 7 systematic reviews/meta-analyses met our inclusion criteria (total: 24 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors; dexamethasone; ankle block and, as an alternative, local anaesthetic wound infiltration; and minimally invasive surgery or percutaneous osteotomy. Insufficient evidence was found for the use of perineural magnesium or liposomal bupivacaine. No evidence was found for continuous popliteal sciatic nerve block or for the use of the plantar compartment nerve block. This review provides an update to the previous guidelines written by the PROSPECT group: there is one important change, minimally invasive surgery or percutaneous osteotomy is recommended over open osteotomy. Contemporary publications confirm the analgesic effects of ankle block as a first-choice modality with wound infiltration as an alternative. In addition, the analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a nonsteroidal anti-inflammatory drug or cyclooxygenase-2 selective inhibitor administered preoperatively or intra-operatively and continued postoperatively, along with systemic dexamethasone, and postoperative opioids for rescue analgesia.

Early recovery of mobilization after geriatric hip fracture is associated with lower complication incidence and mortality. Whether surgical site injection of liposomal bupivacaine (LB) can reduce incidence of major complications after hip fracture in elderly population remains unclear. In this nonrandomized trial, we enrolled participants of an observational cohort who received surgical treatment of a hip fracture and were aged 65years or older from October 2023 to June 2024. We used the participants of this observational cohort from October 2020 to September 2023 as historical control. The primary outcome was a pre-defined composite of major complications including mortality, stroke, myocardial infarction, sepsis, major bleeding, venous thromboembolism, pressure ulcer and pneumonia within 90 postoperative days. Secondary outcomes were all-cause mortality, weightbearing within 24hours after surgery and delirium within 7 postoperative days. In this study, 134 patients received surgical site injection of LB to attenuate postoperative pain intensity and completed the 90-day follow up. Patients in the LB group had a reduced incidence of major complications within 90days (19 [14.2%] patients versus 167 [24.6%] patients compared with patients in the control group, with an adjusted hazard ratio (HR) of 0.55 (95% confidence interval [CI] 0.34 to 0.89, P=0·014). For secondary endpoints, death occurred in 8 (6.0%) patients of LB group and 58 (8.5%) of control group, with an HR of 0.74 (0.35 to 1.56, P=0.432). The incidence of delirium was similar between the two group (LB group 6 patients [4.5%] versus control group 49 [7.2%] patients, P=0.254). Seventy-three patients in LB group (54.5%) achieved weightbearing within 24 while 225 patients in control groups (33.1%) achieved this goal, with an odds ratio of 2.40 (1.64 to 3.51, P<0.001). With surgical site injection of LB, patient might have reduced incidence of major complications. The benefits of LB regarding all-cause mortality and delirium were not observed in this study, possibly due to insufficient power. Future randomized clinical trials with larger sample size were warranted by the current study.

Effect of liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block on postoperative analgesia in patients undergoing shoulder surgery: a randomized, observer-blinded trial

BackgroundPost-craniotomy pain, relatively common in neurosurgery, is often inadequately managed. Preincisional infiltration with ropivacaine provides effective analgesia for post-craniotomy pain, although its duration of action is limited. Liposomal bupivacaine, a long-acting local anesthetic, can provide analgesia for up to 72 h. However, there is a paucity of research on its efficacy in post-craniotomy analgesia. This study hypothesizes that pre-incisional infiltration with liposomal bupivacaine will demonstrate superior analgesic efficacy compared with ropivacaine in patients undergoing acoustic neuroma surgery.MethodsThis single-center, double-blind, randomized controlled study will recruit 112 patients scheduled to undergo acoustic neuroma surgery. We will compare the effects of liposomal bupivacaine and ropivacaine on postoperative pain when administered via preincisional infiltration before surgery. The primary outcome is the pain score at 24 h postoperatively. Secondary outcomes include the incidence of postoperative nausea and vomiting, amount of postoperative analgesic consumption, changes in vital signs before and after skin incision, and postoperative recovery scale.DiscussionThis randomized controlled trial aims to evaluate the superior effects of pre-incisional infiltration of liposomal bupivacaine on postoperative pain control in patients undergoing acoustic neuroma surgery. This may provide a more effective analgesic regimen for patients undergoing craniotomies.

BackgroundThe quality of recovery (QoR) is a multidimensional concept used to evaluate the restoration of physical and psychological functions after surgery. It is a key measure for assessing surgical efficacy, anesthetic modalities, and the effectiveness of perioperative interventions. Liposomal bupivacaine (LB), a long-acting local anesthetic recently introduced, is characterized by its sustained-release profile and prolonged analgesic effect. However, empirical findings regarding the impact of LB on the quality of postoperative recovery remain inconclusive.MethodsOn 5 March 2025, we conducted a systematic search of the PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, and VIP databases to identify randomized controlled trials (RCTs) assessing the efficacy of LB in postoperative recovery. Eligible studies compared postoperative recovery outcomes between patients receiving LB and those in control groups who did not receive LB. The primary outcome of interest was the QoR score measured 72 h after surgery. Secondary outcomes included QoR scores at 24 and 48 h after surgery; pain scores at rest at 24, 48, and 72 h after surgery; incidence of postoperative nausea and vomiting (PONV); cumulative morphine-equivalent opioid consumption within 72 h after surgery; and patient satisfaction.ResultsThis meta-analysis included 11 RCTs comprising a total of 1,357 patients. The findings indicate that the LB group showed a statistically significant improvement in overall QoR scores 72 h after surgery [standardized mean difference (SMD): 0.52; 95% confidence interval (CI): 0.20, 0.85; P = 0.00]. Furthermore, LB use was associated with significantly reduced pain scores at 24, 48, and 72 h after surgery. The LB group also exhibited lower cumulative morphine-equivalent opioid consumption within 72 h after surgery, a reduced incidence of PONV, and significantly higher patient satisfaction scores.ConclusionThe use of LB was associated with improved QoR scores within 72 h after surgery, a reduced incidence of PONV, and decreased opioid consumption. These findings suggest that LB not only improves overall postoperative recovery but also mitigates associated adverse effects, thereby contributing to improved patient satisfaction and a more streamlined recovery trajectory. Nevertheless, further research is needed to assess its long-term efficacy and broader clinical applicability.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD420251003585].

BackgroundLiposomal bupivacaine (LB) can provide prolonged analgesia, which may reduce patients’ opioid consumption, improve comfort, and facilitate recovery. Looser tissue and lower vascularity in the paravertebral space may facilitate LB diffusion and duration, so we investigated the effects of LB in multimodal analgesia after thoracic surgery with paravertebral block.MethodsIn this single-center, double-blind, randomized, parallel-controlled trial, 102 patients undergoing elective thoracoscopic surgery were randomized 1:1 to thoracic paravertebral block with LB (6.67 mg/mL) or ropivacaine hydrochloride (RH; 0.33%). The primary outcome was opioid consumption within 72 h postoperatively. Secondary outcomes included pain ratings at 6, 12, 24, 48, and 72 h postoperatively; rescue analgesia; time to first ambulation and defecation; post-anesthesia care unit and hospital length of stay; and adverse events.ResultsOne patient was excluded due to block failure, leaving 101 patients (LB group, n = 51; RH group, n = 50). LB significantly reduced 72-h opioid consumption compared to RH (difference = –181.4 mg; 95% CI: –232.8, –130.0 mg; P < 0.001), and fewer patients in the LB group required rescue analgesia compared to the RH group (OR: 0.33; 95% CI: 0.13, 0.82; P < 0.05). Pain scores at 24 h were lower in the LB group than RH group (difference = –0.44; 95% CI: –0.84, –0.04; P < 0.05), with no differences at other timepoints. The LB group had shorter time to first ambulation than the RH group [median time (IQR): 20 (18–24) h vs 26 (22–32) h; HR: 3.81; 95% CI: 2.32, 6.19; P < 0.001] and shorter time to defecation [median time (IQR): 56 (42–65) h vs 72 (57–80) h; HR: 3.98; 95% CI: 2.46, 6.44; P < 0.001].ConclusionUltrasound-guided paravertebral block with LB may reduce postoperative opioid consumption and enhance recovery in patients undergoing thoracic surgery.Trial RegistrationChinese Clinical Trials Registry Platform (chictr.org.cn): ChiCTR2400091217.

A Rebuttal to Conrad et al.'s "Commentary on 'A Phase 3 Active-Controlled Trial of Liposomal Bupivacaine via Adductor Canal Block for Total Knee Arthroplasty'".

IntroductionEffective management of postoperative pain is essential for enhancing recovery and improving patient satisfaction after breast surgery. Traditionally, bupivacaine, a long-acting local anaesthetic, has been widely employed for this purpose. More recently, liposomal bupivacaine, a novel prolonged-release formulation, has been introduced as a potential alternative. Although several randomised controlled trials (RCTs) have evaluated these agents, their comparative efficacy remains uncertain. This protocol describes the methodology for a systematic review and meta-analysis designed to assess the analgesic effectiveness of conventional bupivacaine versus liposomal bupivacaine in the setting of breast surgery.Method and analysisThis study is designed as a systematic review and meta-analysis. A comprehensive literature search will be conducted in PubMed, Web of Science, Embase via Ovid, Medline via Ovid and the Cochrane Central Register of Controlled Trials to identify eligible RCTs up to the present date. The search strategy will combine relevant keywords and Medical Subject Headings terms related to bupivacaine, liposomal bupivacaine, breast surgery and pain management. Eligible studies will include RCTs enrolling adult patients (≥18 years) undergoing breast surgery. The interventions of interest are liposomal versus standard bupivacaine, typically administered perioperatively—most commonly intraoperatively via local infiltration or regional block—within the context of surgery under general anaesthesia. The primary outcome is the intensity of postoperative pain within 72 hours. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane Collaboration’s tool. Data will be synthesised using either a random-effects or fixed-effects model, with effect sizes reported as mean differences with 95% CIs for continuous outcomes, and risk ratios for dichotomous outcomes. Subgroup analysis, sensitivity analysis and assessment of publication bias will also be performed to ensure the robustness of findings.Ethics and disseminationEthical approval is not required as only published data will be analysed. The meta-analysis findings will be published in a peer-reviewed journal and presented at relevant scientific conferences.PROSPERO registration numberCRD42023451411.

Real-World Impact of Treatment With Liposomal Bupivacaine on Health Care Resource Utilization, Opioid Consumption, and Cost Among Patients Undergoing Total Knee Arthroplasty in Ambulatory Surgical Settings in the United States.

ObjectivesTo evaluate whether liposomal bupivacaine provides superior postoperative analgesia compared with ropivacaine following haemorrhoidectomy, reduces the need for rescue analgesics in patients with mixed haemorrhoids and maintains a comparable safety profile.DesignProspective, randomised controlled multicentre trial.SettingThree grade 3A general hospitals in Guangxi, China, conducted between September 2023 and July 2024.ParticipantsEligible patients were aged 18–75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids). Key exclusion criteria were severe systemic diseases, history of substance abuse or known allergies to local anaesthetics. A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group.InterventionsPatients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery.Primary and secondary outcome measuresThe primary outcomes were the resting numerical rating scale (NRS) pain scores (0–10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours. The secondary outcomes included the following: (1) exercise NRS pain scores at the same time points; (2) time to first ambulation, ambulation NRS pain scores on postoperative days 1, 2 and 3 and the proportion of patients having ambulation NRS pain scores ≥4; (3) defecation NRS pain scores and the proportion of of patients having score ≥4; (4) the time to the first administration of rescue analgesics and proportion of patients requiring rescue analgesics; (5) proportion of pain-free patients (NRS pain scores ≤1) 0–24, 24–72 and 0–72 hour after surgery; (6) incision assessments on postoperative days 1, 3 and 7 and postoperative adverse events (AEs); and (7) patients’ and researchers’ satisfaction with pain management.ResultsResting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0–2.0 vs 2.0–4.0 for ropivacaine, p<0.001). Exercise NRS pain scores were also significantly lower in the liposomal bupivacaine group (median, 0–2.0 vs 2.0–5.0, p<0.001). Additionally, median ambulation NRS pain scores were reduced in the liposomal bupivacaine group on postoperative days 1–3 (median, 1.0–2.0 vs 3.0–5.0, p<0.001). By 72 hours after surgery, 78.8% of the patients in the liposomal bupivacaine group had defecated, reporting lower defecation NRS pain scores (median, 3.0 vs 5.0, p<0.001). Fewer patients in this group required rescue analgesics (43.9% vs 83.3%, p<0.001). Incision assessment scores were comparable between groups, with no significant difference in AE rates (3.8% vs 1.5%, p=0.444).ConclusionsPerianal infiltration of liposomal bupivacaine significantly alleviates postoperative resting and exercise pain in patients undergoing surgery for mixed haemorrhoids, enhances comfort during ambulation and defecation, reduces the need for additional analgesics and demonstrates a safety profile comparable to that of ropivacaine.Trial registrationchictr.org.cn # ChiCTR2300075276.

Introduction:Effective post-operative pain management is crucial for early mobilization and improved outcomes following total knee arthroplasty (TKA). Multimodal analgesia (MMA) strategies, such as the adductor canal block (ACB) and local infiltration analgesia (LIA) with liposomal bupivacaine, have been developed to enhance pain relief and minimize opioid consumption.Objectives:The aim of this study was to compare the efficacy of standard MMA alone with MMA in combination with ACB or LIA in patients undergoing TKA.Materials and Methods:A prospective comparative study involving 90 patients undergoing unilateral TKA, who were divided equally into three groups: Group A (standard MMA), Group B (MMA + ACB), and Group C (MMA + LIA). Post-operative pain was measured using the visual analog scale (VAS) at 6, 12, 24, and 48 h. Secondary outcomes included opioid consumption and the study of adverse effects.Results:Both ACB and LIA significantly decreased VAS scores compared to standard MMA (P < 0.001). Group C (LIA) showed the lowest pain scores, delayed opioid requirements. Opioid consumption and the incidence of side effects were significantly lower in Groups B and C, with Group C exhibiting the most favorable profile.Conclusion:Both ACB and LIA are effective in improving analgesia and reducing opioid use following TKA. LIA with liposomal bupivacaine provided the most sustained pain relief supporting its use in enhanced recovery protocols.

To determine the pharmacokinetics of a single dose of bupivacaine liposome injectable suspension (BLIS) after SC administration to swan geese (Anser cygnoid). The goal was to assess its potential as an extended-release local anesthetic infiltration in avian patients. It was hypothesized that BLIS at this dose would have low maximal plasma concentrations and a prolonged elimination profile similar to published mammalian data and without adverse effects. A single dose of BLIS at 5.3 mg/kg was infiltrated SC in 6 adult swan geese (3 males and 3 females). Over the following 96 hours, blood samples were collected at 9 time points for analysis of plasma concentrations of bupivacaine. Concentrations were determined using HPLC-MS and plotted against time for pharmacokinetic analysis via nonlinear modeling. The harmonic mean terminal half-life was 14.8 ± 5.5 hours. The mean maximum concentration was 74 ± 21.9 ng/mL and was achieved in all geese within 8 hours. No adverse effects were noted. These results indicate that BLIS in swan geese has an extended absorption and elimination profile compared to local anesthetics in current use in avian species. Protracted duration of local anesthesia in birds may improve patient care, welfare, and surgical outcomes by allowing a reduction of systemic anesthetic and analgesic doses and reducing the frequency of restraint or isolation needed for treatment.

PurposeQuadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) has demonstrated efficacy in postoperative pain management for laparoscopic nephrectomy patients. Liposomal bupivacaine, a novel sustained-release local anesthetic, provides analgesia lasting up to 72 hours. However, its analgesic effect in QLB-LSAL remains undetermined. This randomized controlled trial aimed to compare the postoperative analgesic efficacy of liposomal bupivacaine versus bupivacaine hydrochloride in patients receiving QLB-LSAL after laparoscopic nephrectomy.Patients and MethodsA total of 116 patients were scheduled to undergo elective laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to two groups in a 1:1 ratio. The liposomal bupivacaine group (n = 53) received a mixture of 10 mL of liposomal bupivacaine (133mg) and 10 mL of normal saline, totaling 20 mL, while the bupivacaine hydrochloride group (n = 53) received 20 mL of 0.375% bupivacaine hydrochloride. Post-surgical patient-controlled sufentanil analgesia was provided. The primary outcome was total morphine equivalent consumption within the first 48 hours postoperatively.ResultsThe total consumption of morphine equivalents within 48 hours postoperatively was significantly lower in the liposomal bupivacaine group than in the bupivacaine hydrochloride group (mean ± SD: 31.8 ± 2.3 vs 20.7 ± 2.8, 95% Confidence Intervals: 10.1 to 12.1, P < 0.001). The liposomal bupivacaine group demonstrated superior postoperative recovery quality (P < 0.05), exceeding the minimal clinically important difference, whereas no significant difference in the incidence of adverse events (P > 0.05) was observed between the two groups.ConclusionThe findings demonstrated that administration of liposomal bupivacaine in QLB-LASL significantly reduced postoperative opioid consumption while concurrently improving recovery quality in patients undergoing laparoscopic nephrectomy.