Comparison of liposomal bupivacaine and regular bupivacaine in the transversus abdominis plane for postoperative analgesia: an updated systematic review and meta-analysis

Liposome bupivacaine is a long-acting anesthetic to prolong the duration of analgesia. However, the effectiveness of liposome bupivacaine for providing prolonged analgesia with transversus abdominis plane (TAP) blocks remains uncertain. Therefore, we performed a systematic review and meta-analysis to compare the analgesic efficacy of liposome bupivacaine to regular bupivacaine in TAP blocks. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2024. Randomized controlled trials (RCTs) comparing liposome bupivacaine and regular bupivacaine in TAP blocks were included in this analysis. The primary outcomes were morphine milligram equivalents (MMEs) in the first 24 h and second 24 h after surgery. Secondary outcomes were pain scores at 24 h and 48 h postoperatively, length of hospital stay, and opioid-related side effects. 13 RCTs including 1195 patients were eligible for meta-analysis. The use of liposome bupivacaine in TAP blocks significantly decreased opioid requirement (WMD, -2.40; 95% CI, -4.47 to -0.34; I2 = 78.2%; P = 0.023) in the first 24 h after surgery. No difference was found in the opioid consumption in the second 24 h between the liposome bupivacaine and regular bupivacaine groups. Moreover, no significant difference in pain scores up to 48 h, length of hospital stay, and incidence of opioid-related side effects was found between the two groups. Liposomal bupivacaine for TAP blocks significantly reduced 24-hour opioid consumption (WMD = -2.40 MMEs) but provided no clinically meaningful benefits in pain control, prolonged analgesia, length of stay, or adverse events. Routine use cannot be justified given its higher cost.