2025 FSA Podium and Poster Abstracts

Introduction/Background: Liposomal bupivacaine (LB) is an extended-release formulation of bupivacaine designed to provide up to 72 hours of analgesia. It has been used in orthopedic surgery for postoperative pain control, particularly in procedures such as total knee arthroplasty, total hip arthroplasty, and anterior cruciate ligament reconstruction. However, evidence exists regarding its efficacy in reducing opioid consumption and improving functional recovery when compared to standard bupivacaine or continuous peripheral nerve blocks. Given the differences between the two types of bupivacaine, a critical evaluation of LB’s clinical benefit is necessary.

Methods: To comprehensively examine the impact of liposomal bupivacaine on anesthetic care in orthopedic surgery, an exhaustive systematic literature search was conducted utilizing PubMed and Google Scholar. The following keywords were utilized in combination for data extraction purposes – (Liposomal Bupivacaine AND Total Knee Arthroplasty) OR (Liposomal Bupivacaine AND Total Hip Arthroplasty) OR (Liposomal Bupivacaine AND ACL Reconstruction) OR (Liposomal Bupivacaine AND Shoulder Surgery) OR (Liposomal Bupivacaine AND Regional Anesthesia) OR (Liposomal Bupivacaine AND Opioid Reduction) OR (Liposomal Bupivacaine AND Functional Recovery). Inclusion criteria included articles published within the last 10 years, patients aged 19+, and articles that were randomized controlled trials, meta-analyses, and systematic reviews. Primary outcomes of postoperative pain scores, opioid consumption, and functional recovery were examined. Secondary outcomes such as adverse effects, hospital length of stay, and cost-effectiveness were also examined.

Results: The studies evaluating liposomal bupivacaine for postoperative pain control in various orthopedic procedures produced mixed findings. In total hip arthroplasty, LB significantly reduced postoperative pain scores and opioid consumption at multiple time points. However, in shoulder arthroplasty, LB resulted in higher immediate postoperative pain scores and opioid consumption compared to an indwelling interscalene nerve block, whereas a single-injection brachial plexus block with LB effectively reduced pain and opioid use compared to a placebo. In total knee arthroplasty, periarticular injection of LB showed no significant advantages over standard bupivacaine in terms of pain control, opioid consumption, or early motion. Similarly, in ankle fracture surgery, adding LB to standard bupivacaine did not improve pain relief, opioid use, or patient satisfaction. In anterior cruciate ligament reconstruction, LB resulted in higher acute pain levels compared to a femoral nerve block, though long-term pain and opioid consumption were similar.

Discussion/Conclusion: Overall, while LB demonstrated some benefits in reducing pain and opioid consumption in certain contexts, its effectiveness varied depending on the surgical procedure and comparator analgesic method. In shoulder and knee surgeries, LB was often outperformed by regional nerve blocks and standard bupivacaine, offering no superior clinical advantage. The higher cost associated with LB also raises concerns about its routine use, particularly in procedures where it failed to demonstrate significant benefits. While LB may be a viable option in specific settings, such as when regional anesthesia is not feasible, further high-quality research is needed to optimize dosing, evaluate long-term safety, and determine its ideal role in multimodal pain management strategies.