The use of liposomal bupivacaine for pain control after hand and wrist surgery: A systematic review and meta-analysis.

Abstract

Liposomal bupivacaine (LB) has gained interest as a long-acting local anesthetic, although its utility in hand and wrist surgery remains unclear. This systematic review and meta-analysis evaluated randomized controlled trials (RCTs) comparing LB with conventional anesthetics in patients undergoing hand or wrist surgeries. Searches were performed in PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar through July 2025. Eligible studies reported pain scores and opioid consumption from postoperative day (POD) 0-5, and overall benefit of analgesia scores (OBAS) from POD 1 to 4. Pooled analyses calculated weighted means for pain scores, opioid use, and OBAS, with subgroup analyses for carpometacarpal (CMC) arthroplasty and distal radius open reduction internal fixation (ORIF). Four RCTs involving 211 patients (105 LB, 106 control) were included. Pain scores were not significantly different between groups across POD 0-5. Opioid consumption was marginally reduced on POD 1 with no significant other differences. OBAS scores were lower in the LB group on POD 2 and 3 with no other significant differences. This limited study found that LB use does not significantly reduce postoperative pain and opioid use or enhance analgesia satisfaction compared to standard bupivacaine in hand and wrist surgery. Therapeutic II.