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

Yuqing Chixiaoqun sushuxian liujunhua wenmaoyan huhaonan lihualing huangzhijing zhanghaihui xie^*

• Southern Medical University, Shenzhen School of Clinical Medicine,, China

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 hours 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). Conclusions: LB provided sustained and effective postoperative analgesia for 72 hours after thoracoscopic surgery, while significantly reducing opioid consumption (P<0.01) and supplemental analgesic requirements compared to conventional bupivacaine.