Liposomal Bupivacaine After TKA Lowers Opioid Use and Eases Early Recovery

Key Takeaways

• Liposomal bupivacaine was associated with lower pain scores within 72 hours and lower opioid consumption than ropivacaine hydrochloride.
• Greater joint range of motion and earlier time to first ambulation were reported with liposomal bupivacaine.
• Adverse events were similar, with early complications in one liposomal bupivacaine patient and two ropivacaine patients, none related to analgesic selection.

In a randomized comparison of 121 patients undergoing total knee arthroplasty, peri-articular liposomal bupivacaine was associated with lower early postoperative pain scores and lower opioid consumption than ropivacaine hydrochloride. All patients were treated at a single hospital, with the comparison focused on immediate postoperative comfort and recovery after knee arthroplasty.

The study was a single-center, parallel-group, double-blind randomized trial at Qingdao University Affiliated Hospital, with enrollment from February to June 2025. Patients were randomly assigned in a 1:1 ratio to the liposomal bupivacaine group or the ropivacaine hydrochloride group. Baseline demographic and clinical characteristics were comparable between groups. Primary outcomes were visual analogue scale pain scores within 72 hours after surgery and opioid consumption. Secondary outcomes included range of motion, time to first ambulation, Timed Up-and-Go, 2-minute walk test, length of hospital stay, and postoperative adverse events.

For the primary endpoints, postoperative pain scores and opioid consumption were both lower in the liposomal bupivacaine group. Greater joint range of motion and earlier time to first ambulation were also observed in that group during the initial postoperative period.

Adverse events were similar between groups during the early postoperative period. Early postoperative complications occurred in one patient assigned liposomal bupivacaine and in two assigned ropivacaine hydrochloride, and none were considered related to the assigned analgesic choice.

The authors concluded that liposomal bupivacaine may alleviate postoperative knee pain, reduce opioid use, and facilitate recovery after total knee arthroplasty. The was published on 04 July 2026.