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Randomized Controlled Trial
. 2025 Oct 7:19:9137-9149.
doi: 10.2147/DDDT.S550595. eCollection 2025.

Liposomal Bupivacaine in Ultrasound-Guided Paravertebral Block Reduces Opioid Consumption and Accelerates Recovery After Thoracic Surgery: A Randomized Controlled Trial

Li-Lei Wang #  1   2 , Youzhuang Zhu #  1 , Li-Yuan Hui  2 , Xiao Zhang  1 , Jian-Shuai He  1 , Nian-Liang Zhang  2 , Yuan Dong  3 , Wei Feng  1
Affiliations
Randomized Controlled Trial

Liposomal Bupivacaine in Ultrasound-Guided Paravertebral Block Reduces Opioid Consumption and Accelerates Recovery After Thoracic Surgery: A Randomized Controlled Trial

Li-Lei Wang et al. Drug Des Devel Ther. .

Abstract

Background: Liposomal bupivacaine (LB) can provide prolonged analgesia, which may reduce patients' opioid consumption, improve comfort, and facilitate recovery. Looser tissue and lower vascularity in the paravertebral space may facilitate LB diffusion and duration, so we investigated the effects of LB in multimodal analgesia after thoracic surgery with paravertebral block.

Methods: In this single-center, double-blind, randomized, parallel-controlled trial, 102 patients undergoing elective thoracoscopic surgery were randomized 1:1 to thoracic paravertebral block with LB (6.67 mg/mL) or ropivacaine hydrochloride (RH; 0.33%). The primary outcome was opioid consumption within 72 h postoperatively. Secondary outcomes included pain ratings at 6, 12, 24, 48, and 72 h postoperatively; rescue analgesia; time to first ambulation and defecation; post-anesthesia care unit and hospital length of stay; and adverse events.

Results: One patient was excluded due to block failure, leaving 101 patients (LB group, n = 51; RH group, n = 50). LB significantly reduced 72-h opioid consumption compared to RH (difference = -181.4 mg; 95% CI: -232.8, -130.0 mg; P < 0.001), and fewer patients in the LB group required rescue analgesia compared to the RH group (OR: 0.33; 95% CI: 0.13, 0.82; P < 0.05). Pain scores at 24 h were lower in the LB group than RH group (difference = -0.44; 95% CI: -0.84, -0.04; P < 0.05), with no differences at other timepoints. The LB group had shorter time to first ambulation than the RH group [median time (IQR): 20 (18-24) h vs 26 (22-32) h; HR: 3.81; 95% CI: 2.32, 6.19; P < 0.001] and shorter time to defecation [median time (IQR): 56 (42-65) h vs 72 (57-80) h; HR: 3.98; 95% CI: 2.46, 6.44; P < 0.001].

Conclusion: Ultrasound-guided paravertebral block with LB may reduce postoperative opioid consumption and enhance recovery in patients undergoing thoracic surgery.

Trial registration: Chinese Clinical Trials Registry Platform (chictr.org.cn): ChiCTR2400091217.

Keywords: liposomal bupivacaine; multimodal analgesia; pain management; thoracic paravertebral block; video-assisted thoracoscopic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest and confirm that the study was conducted without any commercial or financial relationships.

Figures

Figure 1
Figure 1
Comparison of pre- and post-administration images of ultrasound-guided paravertebral nerve block. (a) Pre-administration image of ultrasound-guided thoracic paravertebral nerve block. Yellow triangular area represents the paravertebral space, and red line indicates the needle insertion path. (b) Post-administration image of ultrasound-guided paravertebral nerve block. Blue region represents the pleural pressured area caused by injection of local anesthetic. (c) Ultrasound-guided in-plane needle insertion.
Figure 2
Figure 2
Consolidated Standard of Reporting Trials (CONSORT) flow diagram of patients in this trial.
Figure 3
Figure 3
Total postoperative morphine milligram equivalent (MME) consumption and daily breakdown.
Figure 4
Figure 4
Survival curve of time to first ambulation.
Figure 5
Figure 5
Survival curve of time to first defecation.
See this image and copyright information in PMC

References

    1. Holbek BL, Horsleben Petersen R, Kehlet H, Hansen HJ. Fast-track video-assisted thoracoscopic surgery: future challenges. Scand Cardiovasc J. 2016;50(2):78–82. doi: 10.3109/14017431.2015.1114665 - DOI - PubMed
    1. Hill SE, Keller RA, Stafford-Smith M, et al. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104(5):1047–1053. doi: 10.1097/00000542-200605000-00022 - DOI - PubMed
    1. Martins SS, Sampson L, Cerda M, Galea S. Worldwide Prevalence and Trends in Unintentional Drug Overdose: a Systematic Review of the Literature. Am J Public Health. 2015;105(11):e29–49. doi: 10.2105/ajph.2015.302843 - DOI - PMC - PubMed
    1. Graham LA, Illarmo S, Wren SM, Mudumbai SC, Odden MC. Optimal multimodal analgesia combinations to reduce pain and opioid use following non-cardiac surgery: an instrumental variable analysis. Reg Anesth Pain Med. 2025. doi: 10.1136/rapm-2025-106720 - DOI - PubMed
    1. Ding W, Chen Y, Li D, et al. Investigation of single-dose thoracic paravertebral analgesia for postoperative pain control after thoracoscopic lobectomy - A randomized controlled trial. Int J Surg. 2018;57:8–14. doi: 10.1016/j.ijsu.2018.07.006 - DOI - PubMed

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