Victor F. A. Almeida, Glaudir Donato, Andressa Alves de Carvalho, Wanessa Alves de Carvalho, Ammar Lakda, Yara Dias, Manoela Dantas, Pedro Danielian, Eliana F. R. Duraes
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Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (<i>I</i><sup>2</sup> ≥ 25%) or fixed-effects model (<i>I</i><sup>2</sup> < 25%).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = −4.99 mg; 95% CI: [−8.42; −1.56], <i>p</i> < 0.01, <i>I</i><sup>2</sup> = 0%) and POD 2 (MD = −3.35 mg; 95% CI: [−5.74; −0.96], <i>p</i> < 0.01, <i>I</i><sup>2</sup> = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = −0.17; 95% CI: [−0.52; 0.18], <i>p</i> = 0.34, <i>I</i><sup>2</sup> = 83.1%).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.</p>\n </section>\n </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70126","citationCount":"0","resultStr":"{\"title\":\"Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis\",\"authors\":\"Victor F. A. Almeida, Glaudir Donato, Andressa Alves de Carvalho, Wanessa Alves de Carvalho, Ammar Lakda, Yara Dias, Manoela Dantas, Pedro Danielian, Eliana F. R. Duraes\",\"doi\":\"10.1002/micr.70126\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (<i>I</i><sup>2</sup> ≥ 25%) or fixed-effects model (<i>I</i><sup>2</sup> < 25%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = −4.99 mg; 95% CI: [−8.42; −1.56], <i>p</i> < 0.01, <i>I</i><sup>2</sup> = 0%) and POD 2 (MD = −3.35 mg; 95% CI: [−5.74; −0.96], <i>p</i> < 0.01, <i>I</i><sup>2</sup> = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = −0.17; 95% CI: [−0.52; 0.18], <i>p</i> = 0.34, <i>I</i><sup>2</sup> = 83.1%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. 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Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis
Background
Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated.
Objective
This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay.
Methods
A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (I2 ≥ 25%) or fixed-effects model (I2 < 25%).
Results
Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = −4.99 mg; 95% CI: [−8.42; −1.56], p < 0.01, I2 = 0%) and POD 2 (MD = −3.35 mg; 95% CI: [−5.74; −0.96], p < 0.01, I2 = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = −0.17; 95% CI: [−0.52; 0.18], p = 0.34, I2 = 83.1%).
Conclusion
LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.
期刊介绍：
Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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