Efficacy and safety of co-administered bupivacaine and liposomal bupivacaine in interscalene brachial plexus block for shoulder surgery: a systematic review and meta-analysis.

BACKGROUND: The rising incidence of shoulder surgeries highlights significant postoperative challenges, including moderate-to-severe pain, restricted mobility, and opioid-related adverse effects. While interscalene brachial plexus block (ISBPB) utilizing bupivacaine (B) provides effective analgesia, the clinical utility is constrained by a limited duration of action. Liposomal bupivacaine (LB), an extended-release formulation, offers a promising alternative for prolonging analgesia. However, current evidence regarding the comparative efficacy and safety profile remains conflicting. Consequently, a systematic evaluation of the co-administration of B and LB (B + LB) in ISBPB is essential to determine the role of LB in optimizing postoperative pain management for shoulder surgery patients. METHODS: This study included seven randomized controlled trials (RCTs) identified through a comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ProQuest databases. Primary outcomes were opioid consumption and multidimensional pain scores (average, resting, activity, and worst pain scores) on each postoperative day (POD). Secondary outcomes included patient satisfaction and adverse events. The meta-analysis was performed using RevMan 5.4, with continuous outcomes analyzed as mean differences (MDs) or standardized mean differences (SMDs), and dichotomous outcomes as risk ratios (RRs). All effect estimates are reported with their 95% confidence intervals (CIs). RESULTS: Compared to B alone or B with other adjuvant group, the B + LB group exhibited significantly lower opioid consumption on POD 3, and reduced average, resting, and activity pain scores on POD 2. Additionally, the B + LB group showed improvements in worst pain scores on PODs 1-4. Patient satisfaction and adverse event profiles were generally similar between the groups. While an increased risk of hoarseness was specifically observed in the B + LB group on POD 1, the incidence of respiratory complications was similar between the two groups. CONCLUSION: B + LB during ISBPB for shoulder surgery provided superior pain relief on POD 2 and significantly reduced opioid consumption by POD 3, while being associated with an increase in hoarseness risk on POD 1 but comparable overall safety and patient satisfaction.