Comparative Efficacy of Bupivacaine Versus Ropivacaine for Postoperative Pain Control After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Postoperative pain is a significant challenge that can delay early mobilization and prolong hospitalization after total knee arthroplasty (TKA). Effective pain management is critical to promote rehabilitation, reduce opioid consumption, and improve long-term patient outcomes. Bupivacaine and ropivacaine are widely utilized local anesthetics administered by way of peripheral nerve blocks, periarticular injections, and epidural anesthesia to help manage postoperative pain. This systematic review and meta-analysis aimed to compare postoperative pain levels after administering bupivacaine or ropivacaine via peripheral nerve blocks or periarticular injections. Secondary outcomes included length of stay (LOS), rescue analgesia, and motor blockade. Subgroup analysis was performed to differentiate between drug administration by way of peripheral nerve blocks and periarticular injections. A total of nine studies and 656 patients were included. There was no difference in pain levels at 6 hours (MD = 0.12, 95% CI, -0.41 to 0.65, P = 0.66), 12 hours (MD = - 0.01, 95% CI, -0.62 to 0.61, P = 0.98), and 24 hours postoperative (MD = 0.17; 95% CI, -0.27 to 0.61, P = 0.46) between peripheral nerve blocks and periarticular injections of bupivacaine and ropivacaine. At 72 hours postoperative, ropivacaine decreased pain levels when administered through peripheral nerve block only (MD = 0.82, 95% CI, 0.55 to 1.09, P = 0.002). There were no differences in LOS or rescue analgesia, but bupivacaine provided a greater degree of motor nerve blockade (MD = 0.18, 95% CI, 0.01 to 0.35, P = 0.04) assessed by the classical Bromage scale. The findings suggest that bupivacaine and ropivacaine provide comparable analgesic efficacy for postoperative pain control following TKA, indicating that the drug of choice may be due to secondary factors, including cost, availability, or provider preference.