Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 4.
doi: 10.1007/s40122-025-00763-1. Online ahead of print.

Liposomal Bupivacaine vs. Plain Bupivacaine with Dexamethasone for Rhomboid Intercostal Block in the Management of Postoperative Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Non-inferiority Trial

Lei Xie #  1   2 , Yazhi Xi #  1   2 , Xinyao He  1   2 , Mingzi An  2 , Xiaoyu Jia  2 , Zhenping Li  2 , Tao Chen #  3 , Qinghe Zhou #  4
Affiliations

Liposomal Bupivacaine vs. Plain Bupivacaine with Dexamethasone for Rhomboid Intercostal Block in the Management of Postoperative Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Non-inferiority Trial

Lei Xie et al. Pain Ther. .

Abstract

Introduction: Effective and sustained postoperative analgesia is essential to enhance recovery after video-assisted thoracoscopic surgery (VATS). Liposomal bupivacaine, a multivesicular formulation enabling extended local anesthetic release, offers a mechanistic advantage over conventional agents. However, prior comparisons with adjuvant-enhanced regimens such as plain bupivacaine plus dexamethasone were confounded by pharmacological and dose inequivalence. This equivalence-dose randomized controlled trial evaluated whether liposomal bupivacaine provides non-inferior analgesia to the standard combination when administered via rhomboid intercostal block (RIB).

Methods: In this double-blind randomized controlled trial, 90 VATS patients were randomly assigned to receive either: a 20-ml premixed solution containing 93 mg of liposomal bupivacaine combined with 25 mg of plain bupivacaine (liposomal bupivacaine group), or a 20-ml admixture of 105 mg of plain bupivacaine and 5 mg of dexamethasone (plain bupivacaine with dexamethasone group). The primary outcome assessed was the area under the curve (AUC) of the 48-h resting pain numeric rating scale (NRS). Secondary outcomes consisted of opioid consumption, dermatomal spread, and Quality of Recovery-15 scores (QoR-15).

Results: Liposomal bupivacaine was shown to be non-inferior to plain bupivacaine with dexamethasone, with a 48-h NRS AUC of 105.5 ± 13.6 vs. 113.1 ± 16.3 (mean difference - 7.6; 95% CI - 13.9 to - 1.2, upper limit < non-inferiority margin 3.7). Opioid use and dermatomal spread were comparable within the first 24 h (P > 0.05). There was a notable contrast in sustained dermatome blockade at 48 and 72 h between the two groups (P < 0.001). The liposomal bupivacaine group demonstrated a significantly reduced opioid requirement (P = 0.016) within 24-48 h and superior QoR-15 scores on postoperative day 2 (POD2) (P < 0.001). Safety profiles were comparable, with no between-group differences in postoperative nausea and vomiting or other severe complications (P > 0.05).

Conclusions: Rhomboid intercostal block with liposomal bupivacaine provided similar analgesia to plain bupivacaine with dexamethasone for postoperative pain after VATS.

Trial registration: The trial was registered on ClinicalTrials.gov (NCT06392191). Graphical Abstract available in the Supplementary Materials for this article.

Keywords: Analgesia; Liposomal bupivacaine; Rhomboid intercostal block; Video-assisted thoracoscopic surgery.

Plain language summary

This study compared liposomal bupivacaine with plain bupivacaine plus dexamethasone for pain relief after video-assisted thoracoscopic surgery. Liposomal bupivacaine is a special form of local anesthetic that releases medicine slowly, potentially offering longer-lasting pain relief compared to standard treatments. A total of 90 patients undergoing video-assisted thoracoscopic surgery were randomly assigned to receive either liposomal bupivacaine or plain bupivacaine with dexamethasone via a rhomboid intercostal block. The primary outcome was pain relief over 48 h, and additional outcomes included opioid use and postoperative recovery scores. The results showed that liposomal bupivacaine provided similar pain relief to the combination of plain bupivacaine and dexamethasone after video-assisted thoracoscopic surgery. Patients receiving liposomal bupivacaine required fewer opioids after 24 h and had better recovery scores on the second day after surgery. Both treatments had similar safety profiles, with no significant differences in side effects such as nausea. In conclusion, liposomal bupivacaine was as effective as the standard combination for managing postoperative pain after video-assisted thoracoscopic surgery and offered additional benefits, including reduced opioid use and improved recovery.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of Interest: Lei Xie, Yazhi Xi, Xinyao He, Mingzi An, Xiaoyu Jia, Zhenping Li, Tao Chen, Qinghe Zhou declare no conflicts of interest. Ethical Approval: This prospective, randomized controlled trial was approved by the Ethics Committee of the affiliated hospital of Jiaxing University (Ethical number: 2024-KY-226) on 2024-04-01, registered on ClinicalTrials.gov (NCT06392191) on 2024-04-08. Participants provided written informed consent and followed Consolidated Standards of Reporting Trials (CONSORT) guidelines and the Helsinki Declaration of 1964 and its later amendments.

Similar articles

See all similar articles

References

    1. Petersen RH, Holbek BL, Hansen HJ, et al. Video-assisted thoracoscopic surgery-taking a step into the future. Eur J Cardiothorac Surg. 2017;51(4):694–5.
    1. Kaplowitz J, Papadakos PJ. Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth. 2012;26(2):312–21.
    1. Chen JQ, Yang XL, Gu H, et al. The role of serratus anterior plane block during in video-assisted thoracoscopic surgery. Pain Ther. 2021;10(2):1051–66.
    1. An MZ, Xu CY, Hou YR, et al. Effect of intravenous vs. inhaled penehyclidine on respiratory mechanics in patients during one-lung ventilation for thoracoscopic surgery: a prospective, double-blind, randomised controlled trial. BMC Pulm Med. 2023;23(1):353.
    1. Elsharkawy H, Saifullah T, Kolli S, et al. Rhomboid intercostal block. Anaesthesia. 2016;71(7):856–7.

Associated data

LinkOut - more resources