Nerve block or wound infiltration with liposomal bupivacaine for postoperative pain management in open orthopedic surgery: a meta-analysis of 38 randomized controlled trials involving 3,389 patients.

Background: Patients undergoing open orthopedic surgeries often report substantial postoperative pain. The present work aimed to provide effective evidence for perioperative pain management in open orthopedic surgeries through comprehensive electronic database searches and the inclusion of more high-quality randomized controlled trials (RCTs) that report on the safety and effectiveness of liposomal bupivacaine (LB) in these surgeries. Methods: We performed the present work strictly under the guidelines of the Cochrane handbook and PRISMA recommendations. Under the guidance of the established retrieval strategy, two researchers independently performed the literature retrieval. Each included study was assessed in according with Cochrane risk of bias tool. We utilized STATA software to perform all meta-analyses in the current study. Results: 38 RCTs encompassing 3,389 patients were included in this study. The results demonstrated that there was statistical significance in pain intensity scores on POD2 [SMD = -0.25, 95% CI (-0.49 to -0.02)] and a trend toward statistical significance on postoperative day 1 (POD1) [SMD = -0.17, 95% CI (-0.35 to 0.00)] between the two groups. However, no statistical differences in pain scores on POD0, POD3, opioid consumption (total, POD1, POD2, POD3), adverse events, patient satisfaction, and the length of hospital stay. Conclusion: Compared to conventional medications, LB does not demonstrate a significant advantage in perioperative pain management, nor does it significantly reduce opioid consumption. Further high-quality RCTs are required to confirm these findings and greater attention should be given to the long-term safety of LB to ensure its reliability for practical use.