Effect of Liposomal Bupivacaine for Preoperative Thoracic Paravertebral Blockade on Postoperative Pain Following Video-Assisted Thoracoscopic Lung Surgery: A Prospective, Double-Blind, Randomized Controlled Trial.

OBJECTIVES

To compare liposomal bupivacaine versus ropivacaine for acute and chronic pain management via preoperative thoracic paravertebral blockade (TPVB) in thoracoscopic lung resection.

DESIGN

A prospective, double-blind, randomized controlled trial.

SETTING

This study was conducted in a single medical center.

PARTICIPANTS

Sixty adults scheduled for elective thoracoscopic lung resection.

INTERVENTIONS: Preoperative TPVB was performed with liposomal bupivacaine or ropivacaine.

MEASUREMENTS: The primary outcome was the visual analogue scale (VAS) score during rest and dynamic within 72 hours postoperatively. Secondary outcomes included numerical rating scale (NRS) score, opioid consumption, patient-controlled analgesia demands, recovery quality, complications, and chronic pain incidence within 6 months postoperatively.

MAIN

RESULTS

The liposomal bupivacaine group demonstrated significantly lower dynamic cough VAS scores compared to the ropivacaine group at 72 h postoperatively (2.37 ± 0.56 v 3.10 ± 0.82, p < 0.001). Concomitantly, this group showed reduced NRS scores at 36 h and 72 h, decreased sufentanil consumption from 12 to 72 h, fewer patient-controlled analgesia demands at 72 h, and lower chronic pain scores at 1-3 months postoperatively. However, liposomal bupivacaine was associated with a higher incidence of postoperative nausea and vomiting (p < 0.05). No significant intergroup differences were observed in rest VAS scores, recovery quality, or other complications (all p > 0.05).

CONCLUSIONS

Liposomal bupivacaine provided early analgesia comparable to ropivacaine in TPVB for thoracoscopic surgery, but delivered distinct delayed-phase benefits: superior cough-pain control at 72 h, reduced chronic pain scores at 1-3 months, and sustained opioid-sparing effects from 12 to 72 h postoperatively. These advantages support Enhanced Recovery After Surgery goals, though their use must be balanced against a higher postoperative nausea and vomiting incidence and substantial cost. Future implementation requires targeted antiemetic protocols and cost-benefit analyses for high-risk cohorts.