Work

Liposomal bupivacaine intercostal nerve block for pain control in thoracoscopic surgery: a randomized controlled trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Objective This study aimed to evaluate and compare the analgesic efficacy of liposomal bupivacaine (LB) versus conventional bupivacaine hydrochloride for intercostal nerve block after thoracoscopic surgery. Design A prospective, randomized, controlled, single-blind study. Setting The study was conducted in the operating room, post-anesthesia care unit (PACU), and general ward. Participants A total of 100 patients classified as ASA physical status II–III who were scheduled for thoracoscopic surgery were enrolled. Interventions Participants were randomly allocated to receive either LB or conventional bupivacaine hydrochloride via intercostal nerve block, performed under ultrasound guidance. All patients received intravenous patient-controlled analgesia (PCA) without a continuous background infusion. Rescue morphine was administered as needed if the PCA failed to provide adequate pain relief (VAS ≥ 4). Measurements The primary outcome was postoperative pain intensity assessed using the Visual Analog Scale (VAS; 0–10) both at rest and during exercise at 6, 8, 12, 24, 48, and 72 h after surgery. Secondary outcomes included total morphine consumption, PCA demand frequency, patient satisfaction scores, intraoperative remifentanil dose, and length of hospital stay. Safety outcomes included the incidence of postoperative nausea and vomiting (PONV), pruritus, pulmonary complications, and cardiovascular events. Results Baseline characteristics and surgical procedures were comparable between groups. Compared with conventional bupivacaine, the LB group showed significantly lower VAS scores at rest and during exercise at all six postoperative time points (6–72 h; all p < 0.01). PCA demand frequency was significantly reduced in the LB group (median: 11 vs. 30 presses; p < 0.01). Patient satisfaction scores were significantly higher in the LB group (median: 9.0 vs. 7.0; p < 0.01). No significant differences were observed in intraoperative remifentanil consumption ( p = 0.088) or postoperative hospital stay ( p = 0.135). Rescue morphine requirements were minimal in both groups (median: 0 doses). Conclusion LB provided sustained and effective postoperative analgesia for 72 h after thoracoscopic surgery, while significantly reducing opioid consumption ( p < 0.01) and supplemental analgesic requirements compared to conventional bupivacaine. Clinical trial registration www.chictr.org.cn , ChiCTR2300076708.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2025.1647324