Narrative synthesis on liposomal bupivacaine for autologous breast reconstruction pain

Autologous breast reconstruction (ABR), particularly using abdominally based free flaps such as the deep inferior epigastric perforator (DIEP) flap, is associated with significant postoperative pain. Liposomal bupivacaine, a long-acting local anesthetic, has been increasingly incorporated into multimodal analgesia protocols; however, its effectiveness in improving postoperative outcomes remains uncertain. To systematically evaluate the effectiveness and safety of liposomal bupivacaine in reducing opioid consumption and improving recovery outcomes in patients undergoing autologous breast reconstruction. A systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Cochrane CENTRAL, Web of Science, and Scopus was performed up to February 2025. Eligible studies included randomized controlled trials and observational cohort studies comparing liposomal bupivacaine with standard analgesic strategies in ABR. Primary outcomes were total postoperative opioid consumption and length of hospital stay. Secondary outcomes included time to ambulation, time to Foley catheter removal, time to first opioid use, and adverse events. Due to heterogeneity in study designs, interventions, and outcome reporting, a narrative synthesis was performed. Ten studies (5 randomized controlled trials and 5 retrospective cohort studies) involving sample sizes ranging from 16 to 1,017 patients were included. Results for opioid consumption were heterogeneous: some studies demonstrated significant reductions with liposomal bupivacaine (e.g., 512 vs. 395 mg, p = 0.0001; 146.8 vs. 115.5 mg, p  Liposomal bupivacaine may reduce postoperative opioid consumption in selected settings; however, its overall impact on recovery outcomes in autologous breast reconstruction remains inconsistent. Its benefits appear to depend on the underlying analgesic protocol and comparator strategy. Further high-quality, standardized randomized trials are needed to better define its role within multimodal analgesia pathways.