Liposomal bupivacaine and postoperative opioid consumption for oncologic and non-oncologic breast procedures: a literature review and meta-analysis

Abstract

Reduction of postoperative analgesic consumption in breast cancer patients is of significant clinical interest. Some studies have demonstrated promising results related to the efficacy of liposomal bupivacaine (LB), a long-acting local analgesic used intraoperatively, in reducing opioid consumption after aesthetic breast surgery. The purpose of this review is to evaluate postoperative opioid consumption when using LB in aesthetic breast surgery vs oncologic breast surgery to help clinicians better understand trends in pain outcomes in breast cancer patients. A literature search was conducted to identify records reporting postoperative opioid consumption for patients undergoing oncologic mastectomy with and without breast reconstruction (BR) and aesthetic breast surgery. Of the 779 records reviewed, 15 met inclusion criteria representing 2,453 patients. Of these, none of the oncologic procedures without BR showed reduced opioid consumption with LB. A meta-analysis of oncologic procedures with BR and aesthetic breast procedures showed significant effect size (ES) estimates of reduced postoperative opioid consumption when using LB compared to control anesthetics [ES: 1.698 ± 0.8624; 95% confidence interval (CI): 0.005, –3.390; p = 0.049 and ES: 1.212 ± 0.3053; 95% CI: 1.810–0.613; p < 0.001, respectively). In conclusion, intraoperative LB reduces postoperative opioid consumption for oncologic breast surgery with BR and aesthetic breast procedures. LB is understudied in mastectomy without BR and more research is needed. Neoadjuvant treatment and procedural differences could contribute to different pain outcomes. Further investigation could help uncover the etiology of post mastectomy pain syndromes.