The Efficacy of Liposomal Bupivacaine in Thoracic Surgery: A Systematic Review and Meta-Analysis.

Purpose: Patients undergoing thoracic surgery suffer from severe postoperative pain, and a series of complications will occur if there is no effective analgesic treatment. Liposomal bupivacaine (LB) is a novel multivesicular formulation with up to 72 hours of analgesia, which can be used in thoracic surgery. This meta-analysis aimed to evaluate the efficacy of LB in improving recovery in patients undergoing thoracic surgery compared with non-liposomal local anesthetics. Patients and Methods: A literature search was conducted using PubMed, Cochrane Library, Embase, and Web of science, and to identify all observational or retrospective studies and randomized controlled trials (RCTs) from inception to December 2023. The primary outcome was the in-hospital postsurgical opioid consumption in morphine milligram equivalents (MMEs). Secondary outcomes included 24-hour postoperative MMEs, postoperative pain score in the first 24 and 48 hours, hospital length of stay (LOS), time to first ambulation, readmission, and perioperative complications. RevMan 5.3 was used for the data analysis. Results: A total of 10 studies were included in the analysis, of which eight were observational or retrospective analyses and two were RCTs. There were no significant differences in the postoperative MMEs, pain score, LOS, time to first ambulation, readmission, and perioperative complications. Conclusion: According to this meta-analysis, LB was found to be not superior to non-liposomal local anesthetics for analgesic and functional outcomes in thoracic surgery.