Non-Cochrane · intervention · PM42005128
Efficacy of Liposomal Bupivacaine in Third Molar Extraction: A Systematic Review and Meta-Analysis.
Aljumaiaan Mohammed, Owayed Abdulaziz, Altourah Ahmad, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.105390
Findings
4 findings
| Population | ||||
|---|---|---|---|---|
| Adults (>=18 years) undergoing third molar extraction | Liposomal bupivacaine infiltration | Standard bupivacaine or placebo | Postoperative pain intensity (VAS/NRS) 0-48 hours · Oral surgery, third molar extraction · VAS/NRS 0-48 | SMD -0.21 [-0.51, 0.10] GRADE not reported 2 studies · 168 participants |
| Adults (>=18 years) undergoing third molar extraction | Liposomal bupivacaine infiltration | Standard bupivacaine or placebo | Total opioid consumption (morphine milligram equivalents) 48 hours · Oral surgery, third molar extraction · Total MME of opioid consumption at 48 h | MD -1.20 [-1.79, -0.61] GRADE not reported 2 studies · 174 participants |
| Adult patients (>=18 years) undergoing third molar extraction | Liposomal bupivacaine infiltration | Standard bupivacaine or placebo (non-LB control) | Total opioid prescription at 48 hours (MME) 48 hours | MD -66.70 [-72.96, -60.44] GRADE not reported 1 study · 600 participants |
| Adults (>=18 years) undergoing third molar extraction | Liposomal bupivacaine infiltration | Standard bupivacaine or placebo | Cumulative postoperative pain score (NRS) 0-48 hours · Oral surgery, third molar extraction · Cumulative NRS 0-48 | SMD -1.06 [-2.52, 0.39] GRADE not reported 2 studies · 294 participants |
Included primary studies 4
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| James 2022 Pain Levels Did Not Differ Following Uncomplicated Third Molar Extractions Utilizing Liposomal Bupivacaine Versus Standard Bupivacaine. PMID:36243034 | 2023 | this review only | Total opioid consumption (morphine milligram equivalents); Total opioid prescription at 48 hours (MME); Cumulative postoperative pain score (NRS) | not extracted yet |
| Lieblich 2017 (INNOVATE) Liposomal Bupivacaine Use in Third Molar Impaction Surgery: INNOVATE Study. PMID:28858553 | 2017 | this review only | Total opioid consumption (morphine milligram equivalents); Cumulative postoperative pain score (NRS); PM42005128-P1-O4 | not extracted yet |
| Lieblich 2021 A Retrospective Cross-Sectional Study of the Effect of Liposomal Bupivacaine on Postoperative Opioid Prescribing After Third Molar… PMID:33744242 | 2021 | this review only | Total opioid prescription at 48 hours (MME) | not extracted yet |
| Youn 2025 Does Liposomal Bupivacaine Reduce Postoperative Pain Following Third Molar Extractions? A Double-Blinded Randomized Controlled Trial. PMID:39900116 | 2025 | this review only | Total opioid prescription at 48 hours (MME); Cumulative postoperative pain score (NRS); PM42005128-P1-O4 | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adult patients (>=18 years) undergoing third molar extraction | Adults undergoing third molar extraction (n=858) |
| Intervention | Liposomal bupivacaine | Liposomal bupivacaine infiltration (n=417 LB plus 72 split-mouth) |
| Comparison | Standard bupivacaine or placebo | Standard bupivacaine, saline placebo or non-LB standard care (n=369) |
| Outcomes | Postoperative pain, opioid use or prescription | Opioid consumption at 48 hours, opioid prescription at 48 hours, pain intensity 0-48 hours, cumulative NRS 0-48 hours |
| Study designs | RCTs and observational studies | 3 RCTs and 1 retrospective study |
| Timing | Not specified | 48 hours to 96 hours follow-up |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | No | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Partial Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | Yes | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |