JOA - 2026-08-01 - Journal Article; Randomized Controlled Trial; Comparative Study
Liposomal Bupivacaine Versus Ropivacaine With Perineural Dexamethasone in Adductor Canal Block for Total Knee Arthroplasty: A Randomized Clinical Trial.
Liao C, Li J, Hu X, Sun Y, Zheng K, Pan X, Wang L
Topics
Key Takeaway
Liposomal bupivacaine ACB did not reduce the primary endpoint of moderate-to-severe pain with movement at 48h vs ropivacaine+dexamethasone (47.2% vs 63.9%, RR 0.71, p=0.149), but did lower NRS scores and opioid consumption at 24 and 48h.
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Summary
This RCT randomized 72 primary unilateral TKA patients to single-injection ACB with liposomal bupivacaine + bupivacaine HCl (n=36) versus ropivacaine + perineural dexamethasone (n=36), with the primary endpoint being incidence of moderate-to-severe pain with movement at 48h. The primary endpoint was not met (47.2% vs 63.9%, p=0.149). Secondary outcomes favored liposomal bupivacaine: lower NRS scores at rest and with movement at 24 and 48h, reduced opioid consumption in both 0–24h and 24–48h windows, and improved quality of recovery scores at both time points (all p<0.05).
Key Limitation
The trial was underpowered for its primary endpoint, with a wide confidence interval (RR 0.43–1.16) that cannot exclude a clinically meaningful 29% relative risk reduction in moderate-to-severe pain with movement favoring liposomal bupivacaine.
Original Abstract
BACKGROUND
Adductor canal block (ACB) provides effective analgesia for knee surgery while preserving quadriceps muscle strength. However, conventional local anesthetics yield only a short-lasting effect. To extend analgesia duration and reduce opioid usage, the administration of liposomal bupivacaine and perineural dexamethasone has been proposed. The present study assessed and compared the analgesic effectiveness and duration between liposomal bupivacaine and ropivacaine with perineural dexamethasone in patients undergoing total knee arthroplasty (TKA).
METHODS
A total of 72 patients scheduled for primary unilateral TKA were prospectively randomized to receive a single-injection ACB with either liposomal bupivacaine combined with bupivacaine hydrochloride (n = 36) or ropivacaine with perineural dexamethasone (control group, n = 36). The primary endpoint was the incidence of moderate-to-severe pain with movement at 48 hours postoperatively. The secondary outcomes included the incidence of moderate-to-severe pain both at rest and with movement at other time points, numerical rating scale pain score, opioid consumption, quality of postoperative recovery, and adverse events.
RESULTS
At 48 hours, the incidence of moderate-to-severe pain with movement did not differ between the liposomal bupivacaine group and the control group (47.2 versus 63.9%; relative risk 0.71; 95% confidence interval: 0.43 to 1.16; P = 0.149). Patients receiving liposomal bupivacaine showed significantly lower numerical rating scale scores both at rest and with movement at 24 and 48 hours, and consumed less opioid from zero to 24 and 24 to 48 hours (both P < 0.05). Furthermore, these patients showed an improved quality of recovery at 24 and 48 hours compared to the control group (both P < 0.05). The incidence of adverse events did not differ significantly between the two treatment groups (P > 0.05).
CONCLUSIONS
A single-injection ACB with liposomal bupivacaine combined with bupivacaine hydrochloride did not significantly reduce the incidence of moderate-to-severe postoperative pain with movement compared to ropivacaine with perineural dexamethasone after TKA. However, this intervention significantly decreased pain intensity scores, lowered opioid consumption, and improved recovery quality without increasing adverse events compared to the control group.