Liposomal bupivacaine-containing versus standard bupivacaine interscalene nerve blocks in shoulder surgery: A systematic review and meta-analysis

Background This systematic review compares the effectiveness of liposomal bupivacaine (LB) versus bupivacaine hydrochloride (HCl) for interscalene nerve blocks in shoulder surgery. Methods PubMed, EMBASE, and Cochrane databases were searched from 2010 to 2025 for studies comparing LB versus bupivacaine HCl for interscalene blocks in shoulder surgery. Randomized controlled trials (RCTs) were included in the primary analysis; one retrospective cohort study was included in a secondary analysis. Pain scores at 24 and 72 h were primary outcomes; pain at 0 h and opioid consumption at 24 and 72 h were secondary outcomes. Random-effects meta-analysis using restricted maximum likelihood with Hartung–Knapp adjustment was performed. Results Across four RCTs ( n = 181), LB showed statistically lower pain scores at 24 (mean difference −0.6, 95% confidence interval (CI) −0.9 to −0.3) and 72 h (−0.4, 95% CI −0.5 to −0.3), both below minimal clinically important difference thresholds. No significant difference in opioid consumption was observed at 24 or 72 h. Heterogeneity was high at 24 h ( I 2 = 92.5%) and low at 72 h ( I 2 = 0%). Evidence certainty ranged from low to moderate. Discussion LB shows statistically lower pain scores but no clinically meaningful improvement after shoulder surgery. Given the limited clinical significance and higher acquisition cost, routine use of LB for interscalene nerve blocks may not be warranted.