Thoracic paravertebral block with liposomal bupivacaine versus ropivacaine for postoperative analgesia in thoracic surgery: a randomized controlled study.

BACKGROUND

Paravertebral block is a highly effective regional analgesic technique for thoracic surgery. Liposomal bupivacaine (LB) significantly extends the duration of analgesia. However, the efficacy of LB for thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracic surgery (VATS) remains unclear. This trial aimed to evaluate the analgesic efficacy of TPVB with LB following VATS.

METHODS

In this prospective, randomized controlled trial, patients scheduled for VATS were randomly assigned (1:1) to receive either LB or ropivacaine. All patients received a standardized multimodal analgesic regimen, which included a preoperative ultrasound-guided TPVB and patient-controlled intravenous analgesia. The primary outcome was the Numerical Rating Scale (NRS) score for pain during coughing at 24 hours postoperatively.

RESULTS

Among 100 patients undergoing VATS, paravertebral analgesia with LB provided superior pain control compared to ropivacaine. At 24 hours postoperatively, the LB group demonstrated significantly lower median cough NRS pain scores [median: 4 (IQR, 3, 6) vs. 6 (IQR, 5, 7); median difference: -2; P=0.001], as well as reduced resting [2 (IQR, 1, 3) vs. 4 (IQR, 2, 6); P=0.001] and active [3 (IQR, 1, 5) vs. 4.5 (IQR, 3.75, 6.00); P=0.002] NRS pain scores. These analgesic benefits persisted at 48 hours and 72 hours for cough pain (P=0.001 and P=0.02, respectively). The LB group also exhibited a lower incidence of vomiting (4% vs. 26%) and dizziness (14% vs. 36%), along with reduced vasopressor requirements (20% vs. 46%).

CONCLUSIONS

Preoperative administration of LB for TPVB effectively reduced postoperative pain in patients undergoing VATS and was associated with a lower incidence of vomiting and dizziness.

TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400087560 (registered on July 30, 2024).