Iqbal Farhan Sayudo, Teuku Nanda Putra, Syamsul Rizal, Mirnasari Amirsyah, Muhammad Ikhsan, Pratidina Wulandari, Agustina Indah Garnasih, Rafae Ali Khan, Hussam Akram, Yami Bhaskar
Background: Liposomal bupivacaine (LB) is increasingly integrated into Enhanced Recovery After Surgery (ERAS) protocols for abdominally based autologous breast reconstruction. This meta-analysis evaluated LB effectiveness through two contrasts: the incremental effect (ERAS using LB vs. regular anesthetics [RA]) and the package effect (ERAS using LB vs. pre-ERAS care). Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched for studies evaluating LB and RA within ERAS, and pre-ERAS care in transversus abdominis plane (TAP) blocks for abdominally based autologous breast reconstruction. Data were synthesized using a random-effects meta-analysis and reported as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI). Results: Twelve studies involving 1,890 patients were included in the systematic review and meta-analysis. LB showed modest incremental benefit, reducing cumulative pain scores vs. RA (MD − 0.49; 95% CI − 0.87 to − 0.11; p = 0.01), but no significant effect on opioid use or length of stay. ERAS incorporating LB significantly reduced opioid consumption (SMD − 1.40; 95% CI -1.87 to -0.93; p < 0.00001) and hospital stay (MD -0.89; 95% CI -1.27 to -0.51; p < 0.00001) compared with pre-ERAS care. Conclusions: LB adds limited benefit within ERAS but reflects the overall efficacy of ERAS implementation. Level of Evidence: not gradable. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
Medical Research Unit, Universitas Syiah Kuala, Banda Aceh, Indonesia; Beyoutiful Aesthetic Centre, Tangerang Selatan, Indonesia; Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, dr. Zainoel Abidin General Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Medicine, Riphah International University, Rawalpindi, Pakistan; Department of Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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