Bupivacaine 312.5mg/500ml (0.0625%) solution for infusion bottles

IntroductionThis review systematically compares the efficacy and safety of bupivacaine and articaine in third molar surgery, with a focus on postoperative pain control, duration of analgesia, intraoperative outcomes, and hemodynamic stability.MethodsPubMed, Scopus, Web of Science, and CENTRAL were searched through December 24th, 2024, for randomized controlled trials (RCTs) comparing bupivacaine and articaine in third molar surgery. Primary outcomes included postoperative pain intensity (visual analog scale [VAS]), duration of postoperative analgesia, and need for rescue analgesia. Secondary outcomes included anesthesia onset time, intraoperative bleeding, operative time, and hemodynamic parameters. Meta-analysis was performed using a random--effects model.ResultsA total of 11 RCTs involving 749 patients (bupivacaine: 367, articaine: 382) were included. Bupivacaine significantly reduced postoperative pain scores at multiple time points, with the greatest effect observed at 4 h postoperatively (mean difference [MD] = -2.59; 95% confidence interval [CI]: -3.41, -1.77; I2 = 0%). The duration of postoperative analgesia was comparable between groups (MD = 91.22 min; 95% CI: -5.13, 187.57; I2 = 99.68%), with sensitivity analysis confirming this effect. Articaine exhibited a significantly faster onset of anesthesia (MD = 0.74 min; 95% CI: 0.36, 1.12; I2 = 81.05%), while intraoperative pain scores, surgical difficulty, and operative time were comparable between groups. No significant differences were found in hemodynamic parameters, suggesting similar safety profiles.ConclusionBupivacaine provides superior postoperative pain control and prolonged analgesia, making it advantageous for extended pain relief in third molar surgery. However, articaine's faster onset may enhance surgical efficiency. Both anesthetics demonstrated comparable intraoperative efficacy and safety.

Abstract licence: CC BY

BackgroundAutologous breast reconstruction (ABR), particularly using abdominally based free flaps such as the deep inferior epigastric perforator (DIEP) flap, is associated with significant postoperative pain. Liposomal bupivacaine, a long-acting local anesthetic, has been increasingly incorporated into multimodal analgesia protocols; however, its effectiveness in improving postoperative outcomes remains uncertain.ObjectiveTo systematically evaluate the effectiveness and safety of liposomal bupivacaine in reducing opioid consumption and improving recovery outcomes in patients undergoing autologous breast reconstruction.MethodsA systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Cochrane CENTRAL, Web of Science, and Scopus was performed up to February 2025. Eligible studies included randomized controlled trials and observational cohort studies comparing liposomal bupivacaine with standard analgesic strategies in ABR. Primary outcomes were total postoperative opioid consumption and length of hospital stay. Secondary outcomes included time to ambulation, time to Foley catheter removal, time to first opioid use, and adverse events. Due to heterogeneity in study designs, interventions, and outcome reporting, a narrative synthesis was performed.ResultsTen studies (5 randomized controlled trials and 5 retrospective cohort studies) involving sample sizes ranging from 16 to 1,017 patients were included. Results for opioid consumption were heterogeneous: some studies demonstrated significant reductions with liposomal bupivacaine (e.g., 512 vs. 395 mg, p = 0.0001; 146.8 vs. 115.5 mg, p p = 0.002), while others showed no significant differences (e.g., 67 vs. 69 mg, p = 0.52; 215.9 vs. 211 mg, p = 0.883). One study reported higher opioid consumption in the liposomal bupivacaine group (240 vs. 135 mg, p p = 0.0002; 3.217 vs. 2.55 days, p p = 0.05) but not in others. Time to Foley catheter removal was shorter in one trial (2.7 vs. 2.1 days, p = 0.0056) but not consistently across studies. Adverse events were generally comparable between groups, although one study reported a higher rate of seroma formation with liposomal bupivacaine (11% vs. 3%).ConclusionLiposomal bupivacaine may reduce postoperative opioid consumption in selected settings; however, its overall impact on recovery outcomes in autologous breast reconstruction remains inconsistent. Its benefits appear to depend on the underlying analgesic protocol and comparator strategy. Further high-quality, standardized randomized trials are needed to better define its role within multimodal analgesia pathways.

Abstract licence: CC BY