Trial reportBMC anesthesiology2026
Liposomal bupivacaine versus ropivacaine in four-in-one nerve block for total knee arthroplasty: a randomized controlled trial.
Trial report in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundEffective postoperative pain control following total knee arthroplasty (TKA) is essential to enhance for early functional recovery. Liposomal bupivacaine (LB) is a sustained-release formulation of bupivacaine is used to prolong analgesia after regional nerve block. This study evaluated the analgesic efficacy of a single injection of LB for a four-in-one nerve block after TKA.
methodsBetween September 2023 and July 2024, 120 patients aged 65-80 years undergoing unilateral TKA under spinal anesthesia were randomized into two groups: LB (n = 60) and RP (ropivacaine, n = 60). This was a randomized, single-blinded trial. In the post-anesthesia care unit, a four-in-one nerve block was performed under ultrasound guidance using either LB or RP. The primary endpoint was the visual analog scale pain score at rest (VAS-R) at 72 h postoperatively. Secondary outcomes included the visual analog scale pain score during movement (VAS-M) over 72 h, opioid consumption on Post Operative Day 1-3 (POD1-3), muscle strength (Medical Research Council [MRC] scale) over 72 h, range of motion (ROM), and length of hospital stay (LOS).
resultsOver time, VAS-R and VAS-M from 24 to 72 h postoperatively were significantly lower in the LB group compared with the RP group (P < 0.001), effect size analysis revealed moderate effects (r = 0.53-0.88). But the effects in VAS-R and VAS-M within 12 h postoperatively and the VAS-R AUC over 72 h revealed small effects (r = 0.20-0.45). No opioid consumption was recorded in either group on POD 1, whereas opioid consumption was lower in the LB group on POD2 and POD3 (P < 0.001). Knee ROM and Medical Research Council (MRC) grades were higher in the LB group during the first 72 h postoperatively (P < 0.001). LOS did not differ between groups (P = 0.980). Prolonged numbness occurred in 5 patients (8.3%) in the LB group and in none of the RP group, although the between-group difference was not statistically significant.
conclusionIn patients undergoing four-in-one nerve block after TKA, a single injection of LB provided statistically significant but modest improvement in analgesia, particularly between 24 and 72 h postoperatively. LB was also associated with lower opioid consumption on POD2-3 and better early functional recovery. However, the clinical significance of these findings remains uncertain.
trial registrationChinese Clinical Trial Registry, ChiCTR2500102073. Reg Date 08/05/2025. Retrospectively registered.
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