Thoracic Paravertebral Block with Liposomal Bupivacaine Versus Plain Bupivacaine in Patients Undergoing Thoracoscopic Lung Resection: A Randomized Controlled Study

Abstract

Background: The effectiveness of a thoracic paravertebral blockade with liposomal bupivacaine for thoracic surgery pain management is not well examined. This study compared the effects of liposomal bupivacaine and plain bupivacaine on a thoracic paravertebral blockade in adult patients undergoing video-assisted thoracoscopic surgery (VATS).

Methods: Consenting participants (114) scheduled for VATS were randomly assigned to thoracic paravertebral blockade at T4-5 and T7-8 levels with 20 mL (266 mg) liposomal bupivacaine (LB) or 20 mL (37.5 mg) plain bupivacaine (PB) groups. The primary endpoint was opioid consumption at 48 hours postoperatively. Additional main outcomes included the opioid consumption 24 and 72 hours postoperatively; the pain score at rest and coughing 24, 48, and 72 hours postoperatively; Quality of Recovery-15 (QoR-15) scores 24 hours postoperatively, the time to the first analgesia request.

Results: Opioid consumption did not differ between the groups at 48 hours postoperatively. The QoR-15 scores 24 hours after surgery were higher in the LB group than in the PB group (mean [SD], 120.2 [7.1] vs 116.5 [7.8]; P = 0.009). The time to the first analgesia request was longer in the LB group than in the PB group (mean [SD], 585.8min [211.7] vs 315.3min [101.7]; P <0.001). The areas under the curve for the NRS score at rest were 21.2 and 35.8 for the LB and PB groups, respectively (P = 0.002). The NRS scores during coughing did not differ between the two groups, nor did the CPSP three months postoperatively.

Conclusion: Liposomal bupivacaine offers limited but measurable clinical benefits when used for thoracic paravertebral blockade in patients undergoing VATS.

Registration: Chinese Clinical Trial Registry; Registration number: ChiCTR2400081544, URL: https://www.chictr.org.cn/showproj.html?proj=221025.

Keywords: chronic postsurgical pain; liposomal bupivacaine; paravertebral block; video-assisted thoracic surgery.

Figure 1

Flowchart of the study.

Figure 2

Time course of pain intensity at rest (left) and during coughing (right) following video-assisted thoracoscopic surgery in patients receiving liposomal bupivacaine (blue) or plain bupivacaine (red) for paravertebral blockade. Data are presented as mean ± standard deviation. The area under the pain-time curve (AUPC) for NRS at rest was significantly lower in the liposomal bupivacaine group (P = 0.002), while no significant difference was observed for cough pain.