{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:35:00Z","timestamp":1793914500436,"version":"4.8.0"},"reference-count":69,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,6,25]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adding liposomal bupivacaine to brachial plexus block may improve postoperative analgesia after upper limb surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to assess the postoperative analgesic efficacy of adding liposomal bupivacaine to brachial plexus block compared with non-liposomal local anesthetic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence review<\/jats:title>\n                    <jats:p>A systematic literature search was conducted in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Library up to June 30, 2024. Randomized controlled trials (RCTs) that evaluated the postoperative pain scores in patients who received liposomal bupivacaine via brachial plexus block were identified. The primary outcome was resting pain scores (Numerical Rating Scale, 0\u201310) at 24 hours after nerve block injection derived from the random effects model. A mean difference (MD) of 1\/10 was considered to represent a minimal clinically important difference in pain scores. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to examine the level of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      21 RCTs (1478 participants) were included. Liposomal bupivacaine was associated with statistically significant reduction in resting pain scores at 24\u2009hours after nerve block injection compared with non-liposomal local anesthetic (MD=\u20131.04, 95%\u2009CI=\u20131.54 to \u20130.53, p&lt;0.001, 95% prediction interval=\u20133.05 to 0.98). This was associated with significant heterogeneity (Q=107, p&lt;0.001, I\u00b2=81%, tau\n                      <jats:sup>2<\/jats:sup>\n                      =1.0, 95%\u2009CI=0.42\u2009to 2.07) and a low-GRADE rating. Liposomal bupivacaine was also associated with a statistically significant reduction in resting pain scores at 48\u2009hours and 72\u2009hours. Opioid consumption at 0\u201324\u2009hours, 25\u201348\u2009hours and 49\u201372\u2009hours was lower in the liposomal bupivacaine group with statistical significance (p values &lt;0.05). Liposomal bupivacaine was associated with a lower incidence of nausea.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is low-level evidence that liposomal bupivacaine in brachial plexus block may reduce pain intensity after upper limb surgery, but the clinical significance may be limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106583","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T17:55:14Z","timestamp":1753293314000},"page":"611-620","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Addition of liposomal bupivacaine in brachial plexus blocks: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8370-5395","authenticated-orcid":false,"given":"Chung Hin","family":"Shing","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4959-4527","authenticated-orcid":false,"given":"Fengfeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong"},{"name":"Laboratory and Clinical Research Institute for Pain, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6622-6178","authenticated-orcid":false,"given":"Pui Ming","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar Wai Kiu","family":"Tsui","sequence":"additional","affiliation":[{"name":"Department of Orthopedics & Traumatology, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timmy Chi Wing","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8763-5687","authenticated-orcid":false,"given":"Stanley Sau Ching","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, The University of Hong Kong, Hong Kong, Hong Kong"},{"name":"Laboratory and Clinical Research Institute for Pain, The University of Hong Kong, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"2026061805150763000_51.6.611.1","doi-asserted-by":"crossref","first-page":"ii57","DOI":"10.1093\/bja\/aev381","article-title":"Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery","volume":"115 Suppl 2","author":"Cozowicz","year":"2015","journal-title":"Br J Anaesth"},{"key":"2026061805150763000_51.6.611.2","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2024-105286"},{"key":"2026061805150763000_51.6.611.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-020-01044-4","article-title":"Infraclavicular nerve block reduces postoperative pain after distal radial fracture fixation: a randomized controlled trial","volume":"20","author":"Wong","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"2026061805150763000_51.6.611.4","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00590-014-1483-3","article-title":"Interscalene plexus block versus general anaesthesia for shoulder surgery: a randomized controlled study","volume":"25","author":"Lehmann","year":"2015","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2026061805150763000_51.6.611.5","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/ACO.0000000000000651","article-title":"Rebound pain after regional anesthesia in the ambulatory patient","volume":"31","author":"Lavand\u2019homme","year":"2018","journal-title":"Curr Opin Anaesthesiol"},{"key":"2026061805150763000_51.6.611.6","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1213\/ANE.0000000000000688","article-title":"Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? 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