Journal of pain research · 2026
Clinical and Economic Outcomes of Liposomal Bupivacaine, Ropivacaine, and Patient-Controlled Intravenous Analgesia for Adult Video-Assisted Thoracoscopic Surgery: A Retraospective Cohort Study.
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Chen Xiangyan, Fu Tairan, Shen Yan, Chen Yuting, Xu Yi, Xue Hui, Han Xuecheng, Xia Zongling
Аннотация
OBJECTIVE: To evaluate the effectiveness, safety, and cost-effectiveness of three analgesic regimens-PCIA (patient-controlled intravenous analgesia), R (ropivacaine), and LB (liposomal bupivacaine) local infiltration-in adult patients undergoing VATS (video-assisted thoracoscopic surgery).
METHODS: Adults undergoing unilateral VATS in 2024 were retrospectively assigned to PCIA, R, and LB groups. IPTW (inverse probability of treatment weighting) balanced baseline confounders. The primary effectiveness outcome was the 72-h cumulative pain burden (area under the curve, AUC). Secondary outcomes included NRS (numerical rating scale) scores and early recovery indicators; independent factors for postoperative pain were also analyzed. Safety was assessed by adverse event incidences. CEA (cost-effectiveness analysis) was conducted from the Chinese healthcare perspective, with robustness validated by one-way and probabilistic sensitivity analyses (OWSA, PSA).
RESULTS: 829 patients (PCIA: 274; R: 258; LB: 297) were included. After IPTW, baseline characteristics were balanced (SMD < 0.1). The LB group had the lowest 72-h AUC and overall NRS score compared to PCIA (β =-11.01, P = 0.017; 0.80, 95% CI: 0.70-0.89, P = 0.022) and R (β = -30.19, P < 0.001; 1.07, 95% CI: 0.96-1.18, P < 0.001). LB group had the shortest time to first ambulation, and both LB and PCIA groups had shorter hospital stays than the R group (all P < 0.05). No significant differences were found in rescue analgesia incidence or consumption (P > 0.05). Advanced age and tumor history protected against postoperative pain, whereas alcohol history was a risk factor. No significant differences were found in adverse event rates, including postoperative nausea and vomiting, among the groups (all P > 0.05). Economically, PCIA had the highest total cost and R the lowest. LB was dominant over PCIA; versus R, the ICER (incremental cost-effectiveness ratio) for LB was USD 123.29 per 1-point NRS reduction. Sensitivity analyses confirmed robustness.
CONCLUSION: For VATS postoperative analgesia, LB is associated with favorable analgesia and earlier recovery. It may be cost-effective, depending on acceptable WTP thresholds. PCIA and R remain safe and viable alternatives. These findings warrant further validation in large-scale prospective studies.
METHODS: Adults undergoing unilateral VATS in 2024 were retrospectively assigned to PCIA, R, and LB groups. IPTW (inverse probability of treatment weighting) balanced baseline confounders. The primary effectiveness outcome was the 72-h cumulative pain burden (area under the curve, AUC). Secondary outcomes included NRS (numerical rating scale) scores and early recovery indicators; independent factors for postoperative pain were also analyzed. Safety was assessed by adverse event incidences. CEA (cost-effectiveness analysis) was conducted from the Chinese healthcare perspective, with robustness validated by one-way and probabilistic sensitivity analyses (OWSA, PSA).
RESULTS: 829 patients (PCIA: 274; R: 258; LB: 297) were included. After IPTW, baseline characteristics were balanced (SMD < 0.1). The LB group had the lowest 72-h AUC and overall NRS score compared to PCIA (β =-11.01, P = 0.017; 0.80, 95% CI: 0.70-0.89, P = 0.022) and R (β = -30.19, P < 0.001; 1.07, 95% CI: 0.96-1.18, P < 0.001). LB group had the shortest time to first ambulation, and both LB and PCIA groups had shorter hospital stays than the R group (all P < 0.05). No significant differences were found in rescue analgesia incidence or consumption (P > 0.05). Advanced age and tumor history protected against postoperative pain, whereas alcohol history was a risk factor. No significant differences were found in adverse event rates, including postoperative nausea and vomiting, among the groups (all P > 0.05). Economically, PCIA had the highest total cost and R the lowest. LB was dominant over PCIA; versus R, the ICER (incremental cost-effectiveness ratio) for LB was USD 123.29 per 1-point NRS reduction. Sensitivity analyses confirmed robustness.
CONCLUSION: For VATS postoperative analgesia, LB is associated with favorable analgesia and earlier recovery. It may be cost-effective, depending on acceptable WTP thresholds. PCIA and R remain safe and viable alternatives. These findings warrant further validation in large-scale prospective studies.