Effect of Liposomal Bupivacaine in Peripheral Nerve Block Following Thoracoscopic Lung Surgery: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis aims to compare liposomal bupivacaine (LB) with conventional local anesthetics (LAs) in peripheral nerve block following thoracoscopic lung surgery. Methods: Randomized controlled trials (RCTs) evaluating LB and other LAs for postoperative analgesia were retrieved from databases, including PubMed, Embase, Cochrane Library, and Web of Sciencefrom inception to December 2025. The primary outcome was resting Visual Analogue Scale (VAS) at 24 hours. Results: We included 9 RCTs with 930 patients. The LB had a lower resting VAS at 24 hours (mean difference MD = − 0.65, 95% confidence interval CI: − 0.83 to − 0.47). Similar results were shown in the resting VAS at 48 hours (MD = − 0.45, 95% CI: − 0.61 to − 0.29), resting VAS at 72 hours (MD = − 0.33, 95% CI: − 0.56 to − 0.10), movement VAS at 24 hours (MD = − 0.60, 95% CI: − 0.75 to − 0.45), movement VAS at 48 hours (MD = − 0.46, 95% CI: − 0.71 to − 0.21; I2 = 96%), and movement VAS at 72 hours (MD = − 0.60, 95% CI: − 0.98 to − 0.23). Additionally, LB reduced morphine consumption within 24 hours (MD = − 2.68, 95% CI: − 3.84 to − 1.52) and morphine consumption within 72 hours (MD = − 8.76, 95% CI: − 16.13 to − 1.38). However, there were no significant differences between LB and other LAs in morphine consumption within 48 hours and postoperative nausea and vomiting (PONV). Conclusion: Although LB produced statistically significant reductions in resting and movement pain scores at 24, 48, and 72 hours, as well as lower morphine consumption at 24 and 72 hours, the magnitude of these differences is unlikely to be clinically meaningful. Furthermore, no significant differences were observed for 48-hour morphine consumption or PONV. Limitation: The results showed many heterogeneity. There was a lack of data on long-term analgesia and functional outcomes. Keywords: liposomal bupivacaine, pain, nerve block, thoracoscopic, meta-analysis