Key Takeaways & Executive Findings
- •• Local application of liposomal bupivacaine in spinal surgery does not increase treatment-related complications. • Liposomal bupivacaine significantly reduces total opioid consumption after spinal surgery compared to controls. • No significant differences were found in pain scores at various follow-up points between liposomal bupivacaine and control groups. • The evidence is limited by the small number of included studies and the predominance of cohort studies; large randomized controlled trials are needed to confirm these findings.
Abstract
OBJECTIVE: The purpose of this meta-analysis was to assess whether the local application of liposomal bupivacaine in spinal surgery effectively reduces postoperative pain, opioid consumption, and the incidence of related complications. METHODS: The study was conducted strictly in accordance to the methodological guidelines proposed by Cochrane Handbook. The protocol of the present work was registered with PROSPERO. Two researchers independently conducted literature searches in electronic databases including CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar, collecting trials published from January 2015 to December 2024 that met the inclusion criteria. Data extraction and synthesis were performed. Risk of bias or quality of included studies was independently assessed by two reviewers. Statistical analysis was conducted using STATA software. RESULTS: A total of 13 studies involving 2,962 patients were included. The risk of bias in randomized controlled trials was considered low to moderate, and the quality scores of cohort studies were rated as high. The results showed that the total postoperative opioid consumption in the liposomal bupivacaine group was significantly lower than that in the control group [SMD=-0.36, 95%CI(-0.71, -0.02)], but sensitivity analysis indicated that the robustness of this result was not high. In addition, pain scores at each follow-up point, opioid consumption, and the incidence of treatment-related complications were not significantly different between the liposomal bupivacaine group and the control group (P > 0.05). CONCLUSION: Local application of liposomal bupivacaine in spinal surgery does not increase treatment-related complications and can effectively reduce total opioid consumption; however, liposomal bupivacaine did not show a significant advantage in improving postoperative pain after spinal surgery.
1. Introduction
With the aging of the population, low back pain caused by degenerative spinal diseases has become a major cause of disability worldwide [1]. Epidemiological reports indicate that more than 500,000 patients undergo lumbar surgery in the United States each year, and spinal surgery has become an important and growing part of national healthcare expenditures [2]. A cross-sectional study of over 15,000 surgical patients in the UK reported that 11% experienced severe pain and 37% reported moderate pain within 24 hours postoperatively [3]. Surgeries involving the musculoskeletal system are often among the most painful and common procedures [4]. Acute postoperative pain may lead to delayed recovery, prolonged hospital stay, increased complication rates, limited rehabilitation participation, and even progression to chronic pain [5]. Although perioperative analgesic techniques have achieved considerable success, postoperative analgesia for spinal surgery remains a challenge for spine surgical teams [6].
In most surgical perioperative periods, opioids remain the most commonly prescribed medications [7]. Despite their effective analgesic properties, adverse events such as abuse, addiction, and even overdose deaths are frequently reported [8-9]. Pain management for spinal surgery typically combines opioids with non-opioid analgesics; when non-opioid medications reach maximum doses, the only option for uncontrolled pain is to increase opioid doses [10]. In recent years, to reduce opioid use, multimodal analgesia has become increasingly popular in clinical practice. Local infiltration anesthesia, as a component of multimodal analgesia, plays an important role in perioperative pain management for spinal surgery [11].
Conventional local anesthetics used for infiltration are primarily short-acting, often failing to achieve ideal postoperative analgesic goals. Liposomal bupivacaine is a multivesicular liposomal formulation containing bupivacaine, which provides analgesia for more than 72 hours through sustained and slow release of bupivacaine [12]. Currently, liposomal bupivacaine is mainly used in orthopedic surgery, particularly in joint arthroplasty.
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Nong Jiahong, Shi Dayang, Jin Jiacheng, Li Zhuhai, Wei Minke, Wei Jianxun (2026). Local administration of liposomal bupivacaine reduces postoperative pain and complications in spinal surgery: a meta-analysis. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21683
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Frequently Asked Questions
What is liposomal bupivacaine?
Liposomal bupivacaine is a multivesicular liposomal formulation of bupivacaine that provides sustained release of the local anesthetic over an extended period (up to 72 hours), offering prolonged analgesia.
Does liposomal bupivacaine reduce opioid consumption after spinal surgery?
Yes, the meta-analysis found that local application of liposomal bupivacaine significantly reduced total postoperative opioid consumption compared to controls, although the robustness of this finding was not high.
Does liposomal bupivacaine improve postoperative pain after spinal surgery?
The meta-analysis did not find a significant advantage of liposomal bupivacaine over other interventions in improving postoperative pain scores at various follow-up points.
Are there any additional risks associated with liposomal bupivacaine in spinal surgery?
The meta-analysis concluded that local application of liposomal bupivacaine does not increase treatment-related complications compared to controls.
What is the level of evidence for these findings?
The evidence is limited by the small number of included studies and the predominance of cohort studies; large randomized controlled trials are needed to confirm these findings.
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