Application of anterior sciatic nerve block with liposomal bupivacaine in lower leg fracture surgery: a randomized clinical trial.

BACKGROUND

Postoperative acute pain management remains a critical challenge in orthopedic surgery. This study compared the analgesic efficacy of liposomal bupivacaine versus conventional ropivacaine when administered via an ultrasound-guided anterior sciatic nerve block in patients undergoing lower leg fracture surgery.

METHODS

In a randomized, double-blinded trial, eighty adult patients scheduled for elective open reduction and internal fixation (ORIF) of lower leg fractures. Patients were randomized into Group LB (20 mL liposomal bupivacaine, 266 mg) or Group R (20 mL 0.5% ropivacaine). The primary outcome was postoperative pain scores (Visual Analog Scale, VAS) at 6 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4). Secondary outcomes included perioperative opioid use, motor block onset time, Postoperative hospital stay, functional recovery (Barthel Index), and complications.

RESULTS

Group LB exhibited significantly lower VAS scores at T2 (p < 0.001), T3 (p = 0.007), and T4 (p = 0.042), though with higher scores at T1 (p < 0.001). Postoperative hospital stay was shorter in Group LB (p = 0.021), and functional recovery at discharge (Barthel Index) was superior (p = 0.020). No significant differences in perioperative opioid use or complication rates were observed.

CONCLUSIONS

Compared to ropivacaine, liposomal bupivacaine administered via anterior sciatic nerve block provided prolonged postoperative analgesia and was associated with improved functional recovery and shorter hospital stay in patients undergoing lower leg fracture surgery.

TRIAL REGISTRATION: The study protocol was registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR2400084397, 15/05/2024).