Effectiveness of Liposomal Bupivacaine for Postoperative Analgesia After Thoracic Surgery

OBJECTIVE: Given that liposomal bupivacaine (LB) is not currently approved for thoracic surgery, this study evaluated postoperative analgesia after thoracic procedures. METHODS: This retrospective cohort study with propensity score matching yielded 99 matched pairs. Patients were grouped by receipt of a postoperative ultrasound-guided serratus anterior plane block with LB plus standard care versus standard care alone. The primary outcome was the area under the curve (AUC) for pain scores over the first 0-72 postoperative hours. Secondary endpoints included verbal response scale pain scores, opioid consumption, quality of recovery, and hospital length of stay. Statistical significance was defined as P < 0.05. RESULTS: Baseline characteristics were well balanced after matching. The LB group had a lower 0-72 hour pain AUC (110 ± 48 vs. 185 ± 67; P < 0.01), exceeding the prespecified threshold for clinical relevance (at least a 10% reduction), and lower early postoperative pain scores. Opioid consumption was reduced at 24 and 48 hours (both P < 0.01). Quality of recovery scores were higher at 24, 48, and 72 hours, with the 24-hour difference meeting the minimal clinically important difference. Postoperative nausea and vomiting was less frequent from 6 to 24 hours; length of stay did not differ. CONCLUSIONS: Perioperative regional block with LB was associated with reduced pain burden and opioid use after thoracic surgery. Prospective, multicenter randomized trials with longer follow-up and health economic evaluations are needed.