Perioperative Liposomal Bupivacaine for Postoperative Pain Control in Cranial Neurosurgery: A Systematic Review
Eyad Jamileh, Omar Farooq, Mohamed Xamza, Raees Samli, Abdullah Ahmed, Munir AhmedBackground
Postcraniotomy pain is common and contributes to increased opioid use and delayed recovery. Liposomal bupivacaine (LB) is a long‐acting local anaesthetic that provides sustained analgesia for up to 96 h. Its role in cranial neurosurgery remains uncertain.
Methods
A systematic review was conducted in accordance with PRISMA guidelines and registered prospectively on PROSPERO. MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL were searched. Eligible studies assessed perioperative LB in elective cranial neurosurgical procedures and compared it with conventional local anaesthetic or no local infiltration. Primary outcomes were postoperative pain scores and opioid consumption expressed as morphine milligram equivalents. Secondary outcomes included length of stay, complications, and cost.
Results
Four retrospective single‐centre studies involving 184 patients were included. One study examined adult aneurysm craniotomy, and three examined paediatric cranial vault remodelling or Chiari decompression. In the single adult aneurysm‐clipping cohort, mean pain scores, opioid consumption, and length of stay were lower with LB, but the between‐group differences were not statistically significant; reported total analgesic cost was significantly higher. In paediatric cohorts, some retrospective studies reported associations between LB use and lower opioid consumption, including during the first 24 h in one Chiari cohort and across the first three postoperative days in a cranial vault remodelling cohort. Effects on pain scores and length of stay were variable.
Conclusion
Evidence for perioperative LB in cranial neurosurgery is sparse and of low to very low certainty. The single adult aneurysm‐clipping cohort found no statistically significant between‐group differences in pain scores, opioid consumption, or length of stay and reported higher total analgesic cost. Three small retrospective paediatric cohorts reported some associations with lower early opioid consumption, but findings were inconsistent across procedures and outcomes. Current evidence is insufficient to support routine use. Prospective, adequately powered randomised trials are required.