Effect of thoracic paravertebral block with liposomal bupivacaine on quality of recovery after video-assisted thoracic surgery: a randomized controlled trial

Abstract Background The effect of thoracic paravertebral block with liposomal bupivacaine on recovery after video-assisted thoracic surgery remains uncertain. Methods This single-centre, double-blind, randomized controlled trial enrolled ninety adults aged 18 to 65 years who were scheduled for lung cancer resection by video-assisted thoracic surgery. Patients were randomly assigned to receive single-shot thoracic paravertebral block with liposomal bupivacaine 133 mg plus bupivacaine hydrochloride 50 mg, or ropivacaine 100 mg. The primary outcome was the Quality of Recovery-15 score at 48 h postoperatively. Secondary outcomes included postoperative pain intensity, sleep quality, incidence of nausea and vomiting, and cumulative sufentanil consumption after surgery. Results Forty-five patients were included in each group in the final analysis. Patients receiving liposomal bupivacaine and bupivacaine hydrochloride had a higher median QoR-15 score than those receiving ropivacaine at 48 h postoperatively (134 vs. 125, p < 0.001), with a median difference of -9.00 (95% CI, -11 to -7) Additionally, the liposomal bupivacaine and bupivacaine hydrochloride group showed lower median pain scores at rest (1 vs. 2, p < 0.001) and during movement (3 vs. 5, p < 0.001), as well as higher sleep quality score (80 vs. 70, p < 0.001) compared to the ropivacaine group. Furthermore, the cumulative sufentanil consumption was reduced at 24 (35 vs. 40, p <0.001) and 48 (70 vs. 75, p <0.001) hours postoperatively. Conclusion In video-assisted thoracic surgery, single-shot thoracic paravertebral block with liposomal bupivacaine enhances postoperative quality of recovery and reduces pain intensity during mobilization. Trial registration Chinese Clinical Trial Registry, ChiCTR2500101484. First posted date 25 Apr 2025. Implication statement Single-shot thoracic paravertebral block with liposomal bupivacaine improved 48-hr postoperative quality of recovery and reduced movement-evoked pain after video-assisted thoracic surgery, suggesting a practical option for enhanced recovery pathways.