Local administration of liposomal bupivacaine reduces postoperative pain and complications in spinal surgery: a meta-analysis

doi:10.12307/2026.321

Abstract

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 Data, VIP, PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar, collecting eligible trials published between January 2015 and December 2024, followed by systematic data collection and organization. The risk of bias or the quality of each included study was evaluated by two assessors. Data were analyzed using STATA software.
RESULTS: (1) 13 studies involving 2 962 patients were included in the present work. The risk of bias of randomized controlled trials were rated as low to moderate, while the quality of the included cohort studies was allocated to high. (2) The results of this study revealed that total 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)]. However, the sensitivity analysis indicated that the robustness of this result was low. (3) Furthermore, the pain scores, opioid consumption and treatment-related complication rates at each follow-up point in the liposomal bupivacaine group were not significantly different from those in the control group (P > 0.05).
CONCLUSION: Local administration of liposomal bupivacaine in spinal surgery did not increase the risk of treatment-related complications and effectively reduced total opioid consumption. However, no enough evidence supported that liposomal bupivacaine could significantly improve pain intensity during the spinal surgery.

Key words: ">liposomal bupivacaine, spinal surgery, opioids, postoperative pain, complication, perioperative pain management

CLC Number:

Nong Jiahong, Shi Dayang, Jin Jiacheng, Li Zhuhai, Wei Minke, Wei Jianxun. Local administration of liposomal bupivacaine reduces postoperative pain and complications in spinal surgery: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(27): 7182-7188.

Figures/Tables 7

2.3 基于患者自我报告的疼痛得分的Meta分析结果 5个研究[11，21，26，28-29]、6个研究[21，23，26-29]、6个研究分别报道了术后第0，1，3天的疼痛评分[21-23，26，28-29]。各研究间均存在不同等级的异质性(第0天：I2=95.6%，P＜0.001；第1天：I2= 69.9%，P=0.005；第3天：I2=45.2%，P=0.104)，采用随机效应模型进行数据分析。Meta分析结果显示，布比卡因脂质体组在不同随访点的疼痛得分与对照组相比均无统计学差异[第0天：SMD=-0.83，95%CI(-1.79，0.12)；第1天：SMD=-0.31，95%CI (-0.64，0.01)；第3天：SMD=-0.14，95%CI (-0.37，0.09)]，见图3，表明在脊柱手术中局部应用布比卡因脂质体在镇痛方面并没有显著优势。 2.4 阿片类药物消耗量的Meta分析结果 6个研究[6，22-23，27-29]、4个研究[21，23，26，29]、3个研究[21，26，29]、4个研究分别报道了阿片类药物总消耗量以及术后第0，1，3天的阿片类药物消耗量[21-22，26，29]。各研究间均存在显著异质性(总：I2=79.2%，P < 0.001；第0天：I2=81.4%，P=0.001；第1天：I2=83.5%，P=0.002；第3天：I2=0，P=0.701)，采用随机效应模型进行数据分析。Meta分析结果显示，布比卡因脂质体组术后阿片类药物总消耗量比对照组低，差异有显著性意义[SMD=-0.36，95%CI(-0.71，-0.02)]。但两组在术后第0，1，3天的阿片类药物消耗量方面无统计学差异[第0天：SMD=-0.19，95%CI(-0.71，0.34)；第1天：SMD=-0.42，95%CI(-1.03，0.19)；第3天：SMD=-0.13，95%CI (-0.33，0.07)]。见图4。 2.5 与治疗相关并发症的Meta分析结果 3个研究报道了术后与治疗相关的并发症发生率[6，21，27]，各研究间不存在显著异质性(I2=0，P=0.629)，采用固定效应模型进行数据分析。Meta分析结果显示布比卡因脂质体组术后并发症发生率与对照组相似，无统计学差异[RR=1.02，95%CI(0.62，1.68)]。对常见的并发症进行亚组分析，发现两组在各并发症发生率方面也无统计学差异[恶心：RR=1.24，95%CI(0.98，1.56)；便秘：RR=1.09，95%CI(0.75，1.58)；瘙痒：RR=0.62，95%CI(0.37，1.06)]，见图5。 2.6 敏感性分析与发表偏倚对纳入的研究数超过5个的结局指标进行敏感性分析。结果显示除了阿片类药物总消耗量这一结局以外，其他结局指标在剔除某一研究后，剩余研究的合并结果与原合并结果仍保持一致，见表3，表明这些结局指标的稳健性好，证据强度高。当前研究纳入的文献较少，因此，没有采用漏斗图进行发表偏倚的检测。"

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