Liposomal Bupivacaine for Fascial Plane Block: Comment

I write to offer a comment and a suggestion on the systematic review and meta-analysis by Hussain et al. of local anesthetics used for fascial plane block.¹  This report compared analgesia between liposomal bupivacaine and plain bupivacaine, the primary outcome being rest pain scores over the 24-to-72 h postoperative interval expressed as an area under the curve.¹  Using data from 874 patients in 13 studies and adopting a Hartung-Knapp-Sidik-Johnkman random-effects model with the pain severity difference between treatments transformed as a standardized mean difference, the authors report in the abstract and the body that “No difference was observed between the two groups for area under the curve scores, with a standardized mean difference (95% CI) of –0.21 cm.h (–0.43 to 0.01; P = 0.058; I² = 48%).” The authors used excellent statistical methods and software within frequentist statistical methodology; inferences were made by null hypothesis significance testing....