Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections

Figures & data

Figure 1. Flow diagram showing article selection process.

Table 1. Studies included in the systematic review.

Study	Type	Indications	Patients (n) in LB group	Control group	Mean age in years (LB/Controls)	Males % (LB/Controls)	Mode of administration in LB group	Quality score
Beck et al. [19]	Retrospective cohort study	Lap/open colectomy	66	167	59.8/54.7	39.4/46.1	Local injection	16
Knudson et al. [18]	Randomized double-blind controlled trial	Lap/open colectomy	27	30	66.2/67.9	56/50	Local injection	See Table 2
Keller et al. [11]	Retrospective, Matched study	Laparoscopic colectomy	25	25	59.4/59.7	50/50	TAP block and local infiltration	20
Cohen et al. [10]	Phase IV open label Sequential cohort study	Open colectomy	21	18	53/54	33/44	Local	19
Candiotti et al. [21]	Prospective phase IV multi-center sequential cohort study	Laparoscopic colectomy	26	56	55/59	46/50	Local	19
Stokes et al. [20]	Retrospective cohort study	Lap/open colectomy	303	104	53.8/51.8	49.2/56.2	TAP block	19
Keller et al. [22]	Retrospective, Matched study	Single incision lap colectomy	70	70	58.7/56.3	50%/51.4%	Local	19

LB: liposomal bupivacaine; TAP: transversus abdominis plane.

Table 2. Risk of bias table and modified Jadad score evaluating the quality of randomized controlled trial by Knudson et al. [16].

Type of bias	Knudson et al.
Random sequence generation [selection bias]	+
Allocation concealment [selection bias]	+
Blinding of participants and personnel [performance bias]	+
Blinding of outcome assessment [detection bias]	+
Incomplete outcome data [attrition bias]	+
Selective reporting [reporting bias]	+
Other bias	?

+ indicates that the study was without bias.

Modified Jadad score for randomized controlled trial.

Was the study described as randomized?	Yes	+1
Was the method of randomization appropriate?	Yes	+1
Was the study described as double blinded?	Yes	+1
Was the method of blinding appropriate?	Yes	+1
Was there a description of withdrawals and dropouts?	Yes	+1

Figure 2. Forest plot showing the individual and pooled estimate of length of stay in patients receiving liposomal bupivacaine vs. controls.

Figure 3. Forest plot showing the individual and pooled estimate of IV opioid used in patients receiving liposomal bupivacaine versus controls.

Figure 4. Forest plot showing the individual and pooled estimate of pain score in patients receiving liposomal bupivacaine versus controls.

Figure 5. Forest plot showing the individual and pooled estimate of hospitalization costs in patients receiving liposomal bupivacaine versus controls.

Beck DE, Margolin DA, Babin SF, et al. Benefits of a multimodal regimen for postsurgical pain management in colorectal surgery. Ochsner J. 2015;15:408–412.

 PubMed Web of Science ®Google Scholar

Knudson RA, Dunlavy PW, Franko J, et al. Effectiveness of liposomal bupivacaine in colorectal surgery: a pragmatic nonsponsored prospective randomized double blinded trial in a community hospital. Dis Colon Rectum. 2016;59:862–869.

 PubMed Web of Science ®Google Scholar

Keller DS, Tahilramani RN, Flores-Gonzalez JR, et al. Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes. Surg Endosc. 2016;30:2192–2198.

 PubMed Web of Science ®Google Scholar

Cohen SM. Extended pain relief trial utilizing infiltration of Exparel((R)), a long-acting multivesicular liposome formulation of bupivacaine: a Phase IV health economic trial in adult patients undergoing open colectomy. J Pain Res. 2012;5:567–572.

 PubMedGoogle Scholar

Candiotti KA, Sands LR, Lee E, et al. Liposome bupivacaine for postsurgical analgesia in adult patients undergoing laparoscopic colectomy: results from prospective phase IV sequential cohort studies assessing health economic outcomes. Curr Ther Res Clin Exp. 2014;76:1–6.

 PubMedGoogle Scholar

Stokes AL, Adhikary SD, Quintili A, et al. Liposomal bupivacaine use in transversus abdominis plane blocks reduces pain and postoperative intravenous opioid requirement after colorectal surgery. Dis Colon Rectum. 2017;60:170–177.

 PubMed Web of Science ®Google Scholar

Keller DS, Pedraza R, Tahilramani RN, et al. Impact of long-acting local anesthesia on clinical and financial outcomes in laparoscopic colorectal surgery. Am J Surg. 2017;214:53–58.

 PubMed Web of Science ®Google Scholar