Effects of Liposomal Bupivacaine for Superficial Parasternial Intercostal Plane Block on Postoperative Stress and Analgesia in Patients Undergoing Median Sternotomy: A Prospective, Randomized, Double-Blind Trial.

BACKGROUND

Liposomal bupivacaine may provide prolonged postoperative analgesia, but its efficacy in median sternotomy remains underexplored. This study evaluated whether liposomal bupivacaine for superficial parasternal intercostal plane (SPIP) block improves postoperative analgesia and reduces surgical stress in patients undergoing median sternotomy.

METHODS

In this prospective, randomized, double-blind controlled trial, 44 patients undergoing elective median sternotomy under cardiopulmonary bypass were randomized to receive SPIP block with either liposomal bupivacaine or ropivacaine. Primary outcomes were visual analog scale (VAS) pain scores within 72 h postoperatively and serum levels of stress markers, including angiotensin II (Ang-II) and interleukin-6 (IL-6). Secondary outcomes included patient-controlled intravenous analgesia boluses, postoperative nausea and vomiting, extubation time, intensive care unit stay, Quality of Recovery-15 (QoR-15) scores, and complications.

RESULTS

Compared with the ropivacaine group, the liposomal bupivacaine group showed significantly lower VAS pain scores from 18 to 72 h postoperatively (P < 0.05). Although Ang-II and IL-6 levels increased postoperatively in both groups, concentrations were significantly lower in the liposomal bupivacaine group (P < 0.01). Patients receiving liposomal bupivacaine required fewer analgesic boluses, had shorter intensive care unit stays, faster postoperative recovery, lower incidence of postoperative nausea and vomiting, and significantly improved QoR-15 scores (all P < 0.05). No significant differences were observed in extubation time, hospital stay, or hospitalization costs. No block-related complications were observed.

CONCLUSION

Liposomal bupivacaine for SPIP block improved analgesia up to 72 hours after surgery, may attenuate the surgical stress response, and could promote early recovery in patients undergoing median sternotomy under cardiopulmonary bypass.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400091199).