Intercostal nerve block with liposomal bupivacaine versus no regional analgesia after uniportal thoracoscopic surgery: A randomized controlled trial.

Abstract

To evaluate intercostal nerve block (administered with liposomal bupivacaine) compared with no regional analgesia after video-assisted thoracoscopic surgery lung resection. In this randomized controlled trial, patients undergoing video-assisted thoracoscopic surgery were randomly assigned 1:1 to receive intercostal nerve block using liposomal bupivacaine or standard care without regional analgesia (control). The primary end point was resting pain at 24 hours postoperatively. Secondary outcomes included cumulative resting pain over 72 hours, opioid consumption in morphine milligram equivalents (MME), Total Quality of Recovery-15 scores, length of stay, and adverse events. A total of 199 patients were included (intervention, n = 100; control, n = 99). Median resting pain at 24 hours was lower with intercostal nerve block using liposomal bupivacaine than with control (2.0 [interquartile range, 1.0-3.0] vs 3.0 [interquartile range, 3.0-4.0]; <i>P</i> &lt; .001). Cumulative opioid consumption was reduced by 18.0%, 13.1%, and 15.1% at 0 to 24, 24 to 48, and 0 to 48 hours, corresponding to absolute decreases of 4.7, 5.0, and 9.8 mg MME, respectively. Total Quality of Recovery-15 scores were higher in the intervention group at 24 and 48 hours (both <i>P</i> &lt; .001). Median length of stay was similar (5.0 vs 6.0 days; <i>P</i> = .147), and overall postoperative adverse event rates were comparable between groups. Compared with no regional analgesia, intercostal nerve block with liposomal bupivacaine reduced resting pain at 24 hours after video-assisted thoracoscopic surgery lung resection and was associated with lower opioid consumption and improved early recovery. However, this study cannot confirm its superiority over standard bupivacaine or other regional blocks.