Efficacy of thoracic paravertebral block with liposomal bupivacaine for postoperative analgesia in patients undergoing liver resection: A randomized controlled trial

Abstract

Patients often suffer from moderate to severe acute postoperative pain after liver resection, and the use of liposomal bupivacaine (LB) for pain management is widespread. However, no studies have demonstrated the effect of postoperative analgesia with LB administered via a thoracic paravertebral block (TPVB). The aim of this study was to evaluate the effects of TPVB-administered LB and standard bupivacaine (SB) on opioid sparing and postoperative recovery following liver resection METHODS: In this randomized, prospective, single-blind study, 96 patients were randomly (1:1) assigned to two groups. The primary outcome was cumulative opioid consumption over the first 72 h. the secondary outcomes were the time to first opioid use after surgery, plasma bupivacaine concentration, quality of recovery 40 (QoR-40) score area under the curve (AUC) from 24 to 72 h, pain visual analog scale (VAS) score AUC from 6 h to 3 months, postoperative plasma inflammatory factor levels, and sleep quality at 3 months after surgery RESULTS: Ninety-three patients (age (SD), 59.8 (10.5) years; 74 males, 79.6 %) were included in the final analysis. The cumulative opioid consumption was lower in the LB group 63.0 (IQR: 10.5, 90.0) than in the SB group of patients receiving the (72.0 (IQR: 27.0, 135.0) mg oral morphine equivalent (p = 0.041). Compared to those in the SB group, the time to first opioid use was longer, and the plasma bupivacaine and TNF-α levels were greater postoperatively in the LB group. There was no difference in other outcomes between the two groups, and there were no adverse events in this study CONCLUSION: TPVB-administered LB reduced total opioid consumption postoperatively in patients undergoing hepatectomy in the first 72 h.

Keywords: Liposomal bupivacaine; Liver resection; Opioid; Postoperative analgesia; Thoracic paravertebral block.