Efficacy of liposomal as compared to standard bupivacaine for intercostal nerve blocks in patients undergoing minimally invasive thoracic surgery: a systematic review and meta-analysis.

Background: This review aimed to provide evidence on the efficacy of liposomal bupivacaine as compared to standard bupivacaine for intercostal nerve blocks (ICB) in patients undergoing minimally invasive thoracic surgery.

Methods: Randomized controlled trials (RCTs) and comparative observational studies published on the databases of PubMed, CENTRAL, Web of Science, and Embase up to June 20, 2024, were included. Total opioid consumption in morphine equivalents, pain scores, and length of hospital stay (LOS) were compared.

Results: Two RCTs and eight observational studies were included. Eight hundred and four patients received liposomal bupivacaine while 631 patients received standard bupivacaine in the included studies. The meta-analysis showed that the use of liposomal bupivacaine for ICB did not reduce opioid consumption as compared to standard bupivacaine at 24 h, 48 h, and for the total duration of hospitalization. Pain scores were also not significantly different between the two groups at 24 h and 48 h. Meta-analysis showed that there was no difference in the LOS between intervention and control groups. Subgroup analysis based on study design also generated similar results.

Conclusions: Mostly low-quality evidence shows that liposomal bupivacaine does not offer additional benefits over standard bupivacaine when used for ICB in patients undergoing minimally invasive thoracic surgery.