Meta-analysis on the Efficacy of Liposomal Bupivacaine in Reducing Postoperative Pain Following Perianal Surgery

Abstract

Background: Liposomal bupivacaine (LB), a novel long-acting local anaesthetic, possesses a multi-vesicular liposomal structure that delays drug release, theoretically providing up to 72 hours of postoperative analgesia. However, high-quality studies evaluating LB's analgesic efficacy in perianal surgery (including haemorrhoidectomy, anal fistula, and perianal abscess surgery) remain limited, with existing evidence exhibiting significant heterogeneity. Consequently, we conducted this meta-analysis to comprehensively evaluate the efficacy and safety of LB compared with conventional bupivacaine and placebo in post-operative analgesia for perianal surgery. Methods: Computerised searches were performed in English databases (Cochrane Library, Embase, PubMed) and Chinese databases (Wanfang Database, China National Knowledge Infrastructure, VIP Database, China Biomedical Literature Database). All randomised controlled trials (RCTs) published between 1983 and 2025 concerning LB for postoperative analgesia following perianal surgery were included. The methodological quality of included studies was assessed using the Cochrane risk of bias tool, and meta-analysis was performed using Stata 8.0 software. Results: Four randomised clinical trials involving 425 patients undergoing perianal surgery were included. A total of 219 patients (51.5%) received LB therapy, while 206 (48.5%) received bupivacaine or placebo. The LB group exhibited significantly reduced VAS scores at 24 hours postoperatively [SMD = -0.91, 95% CI (-1.25, -0.57)]. Pain scores at 72 hours were significantly lower in the LB groups (199, 266, and 300 mg) compared to the control group (p = 0.002). The time to first opioid use was significantly delayed in the LB groups compared with the control group: LB 199 mg (11h vs 8h), LB 266 mg (19h vs 8h), LB 300 mg (14.2h vs 1.2h) (p<0.0001). Mean opioid doses administered within 72 hours were significantly reduced in the LB 266 mg group (3.7 vs 10.2 mg) and LB 300 mg group (22.3 vs 29.1 mg) compared with the control group. Patient satisfaction was significantly enhanced [RR=1.26, 95% CI (1.13, 1.40)]. No significant difference in adverse reaction incidence was observed between LB groups and the control group. Conclusion: LB demonstrated comparable clinical efficacy to the control group in post-operative analgesia following perianal surgery, including reduced VAS scores within 24 hours, significantly diminished pain within 72 hours, decreased opioid requirements, delayed first opioid administration, and enhanced patient satisfaction, while exhibiting favourable safety profiles.