Liposomal bupivacaine in thoracic paravertebral nerve block for postoperative analgesia following video-assisted thoracoscopic lobectomy: a prospective, double-blind, randomized controlled trial

The limited duration of action of bupivacaine hydrochloride in thoracic paravertebral nerve block (TPVB) contributes to high rates of acute and chronic postsurgical pain (CPSP) following video-assisted thoracoscopic surgery (VATS). The efficacy of long-acting liposomal bupivacaine (LB) in VATS remains inconclusive. This randomized, double-blind trial involved 146 patients undergoing elective VATS, who received TPVB with either 20 ml of 0.887% liposomal bupivacaine (LB group) or 20 ml of 0.25% bupivacaine hydrochloride (B group). This study was registered with the Chinese Clinical Trial Registry on July 31, 2024. The primary outcome was the area under the curve (AUC) of numerical rating scale (NRS) pain scores over the first 72 h postoperatively. Secondary outcomes included NRS scores at 72 h and at 1, 3, and 6 months postoperatively; concentrations of inflammatory markers within 48 h postoperatively; analgesic consumption; patient-controlled intravenous analgesia (PCIA) presses; postoperative hospitalization duration; and the incidence of postoperative adverse reactions and complications. The AUC of NRS scores at rest and during movement was significantly lower in the LB group compared to the B group during the first 72 h postoperatively (P < 0.05). At 1 and 3 months postoperatively, the LB group showed significantly lower NRS scores and a 58% reduction in CPSP incidence (28.6% vs. 48.6%; P < 0.001). The LB group required fewer effective and total PCIA presses, as well as reduced supplemental analgesic doses during the first 48 postoperative hours (P < 0.01). Fewer complications, including subcutaneous emphysema and pneumonia, were observed in the LB group (P < 0.01). Additionally, inflammatory responses were attenuated, as indicated by decreased interleukin-1β levels within 48 h and lower C-reactive protein levels at 24 h (P < 0.05). No significant differences were observed between the groups in other secondary outcomes. Liposomal bupivacaine for TPVB significantly alleviated both acute and chronic postsurgical pain, reduced analgesic requirements, and did not increase pulmonary complications.