We commend Ilfeld et al. for their comprehensive review regarding the clinical effectiveness of liposomal bupivacaine when administered via infiltration or peripheral nerve block for postoperative analgesia. Since its approval by the U.S. Food and Drug Administration (Silver Spring, Maryland) in 2011, liposomal bupivacaine has been widely adopted and its clinical applications expanded. In the midst of the opioid epidemic, it is easy to understand how long-acting, nonopioid alternatives like liposomal bupivacaine have been eagerly embraced by many physicians. Along with many regional anesthesiologists, we have remained open to the concept but skeptical of the results. The considerable increase in randomized, controlled trials over the last few years has not only shown that the “evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics,” but it is also fraught with...

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