The Efficacy of Liposomal Bupivacaine Using Periarticular Injection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

J Arthroplasty. 2017 Apr;32(4):1395-1402. doi: 10.1016/j.arth.2016.12.025. Epub 2016 Dec 23.


Background: Total knee arthroplasty (TKA) is gradually emerging as the treatment of choice for end-stage osteoarthritis. In the past, the method of liposomal bupivacaine by periarticular injection (PAI) showed better effects on pain reduction and opioid consumption after surgery. However, some recent studies have reported that liposomal bupivacaine by PAI did not improve pain control and functional recovery in patients undergoing TKA. Therefore, this meta-analysis was conducted to determine whether liposomal bupivacaine provides better pain relief and functional recovery after TKA.

Methods: Web of Science, PubMed, Embase, and the Cochrane Library were comprehensively searched. Randomized controlled trials, controlled clinical trials, and cohort studies were included in our meta-analysis. Eleven studies that compared liposomal bupivacaine using the PAI technique with the conventional PAI method were included in our meta-analysis. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and Cochrane Handbook were applied to assess the quality of the results published in all included studies to ensure that the results of our meta-analysis were reliable and veritable.

Results: Our pooled data analysis demonstrated that liposomal bupivacaine was as effective as the control group in terms of visual analog scale score at 24 hours (P = .46), 48 hours (P = .43), 72 hours (P = .21), total amount of opioid consumption (P = .25), range of motion (P = .28), length of hospital stay (P = .53), postoperative nausea (P = .34), and ambulation distance (P = .07).

Conclusion: Compared with the conventional PAI method, liposomal bupivacaine shows similar pain control and functional recovery after TKA. Considering the cost for pain control, liposomal bupivacaine is not worthy of being recommended as a long-acting alternative analgesic agent using the PAI method.

Keywords: liposomal bupivacaine; meta-analysis; multimodal analgesia; pain management; periarticular injection; total knee arthroplasty.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Analgesics / administration & dosage
  • Analgesics, Opioid / administration & dosage
  • Anesthetics, Local / administration & dosage*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Bupivacaine / administration & dosage*
  • Humans
  • Injections, Intra-Articular
  • Length of Stay
  • Liposomes
  • Pain Management / methods
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Postoperative Nausea and Vomiting
  • Range of Motion, Articular
  • Recovery of Function / drug effects*


  • Analgesics
  • Analgesics, Opioid
  • Anesthetics, Local
  • Liposomes
  • Bupivacaine