Division of Thoracic and Esophageal Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pa.
Division of Thoracic Surgery, Department of Surgery, Sinai Hospital, Baltimore, Md.
J Thorac Cardiovasc Surg. 2021 May;161(5):1652-1661. doi: 10.1016/j.jtcvs.2020.01.112. Epub 2020 Apr 11.
Thoracic surgery can cause significant pain, and multiple strategies have been developed to control pain after surgery. We compared 2 bupivacaine formulations given intraoperatively: bupivacaine with epinephrine (1,200,000) or liposomal bupivacaine.
This was a randomized, open-label study (NCT03560362). Eligible patients were adults scheduled for a minimally invasive lung procedure. Incision sites were injected with bupivacaine with epinephrine or liposomal bupivacaine before incision, and each intercostal space was injected with 1 mL of bupivacaine with epinephrine or liposomal bupivacaine entering the thoracic cavity. Patient-controlled analgesia was initiated in the recovery room. Pain was recorded using a visual analog scale. The primary outcome was the amount of narcotics taken during the postoperative hospital stay.
We recruited 50 patients; 25 received bupivacaine with epinephrine, and 25 received liposomal bupivacaine. The treatment groups were similar in age, histology, and procedure performed. There were no statistical differences between the treatment groups in the amount of narcotics required during the hospital stay (36.3 mg for bupivacaine and 38 mg for liposomal bupivacaine) or in pain assessed the day of surgery (5 and 5), the first day (3.5 and 2.3), second day (3 and 2.6), 2 weeks (0 and 1), or 3 months (0 and 0) postoperatively. Hospital length of stay and complications were also similar.
In a small, randomized study, we did not find significant differences between bupivacaine with epinephrine or liposomal bupivacaine in mitigating pain after minimally invasive lung resection. We currently favor using the less expensive nonliposomal bupivacaine preparations until additional data are available.
胸外科手术后会引起明显疼痛，因此已经开发出多种策略来控制术后疼痛。我们比较了两种术中使用的布比卡因制剂：含肾上腺素的布比卡因（120 万）或脂质体布比卡因。
这是一项随机、开放标签研究（NCT03560362）。符合条件的患者为计划接受微创肺手术的成年人。切口部位在切开前注射含肾上腺素的布比卡因或脂质体布比卡因，每个肋间空间注射 1 mL 进入胸腔的含肾上腺素的布比卡因或脂质体布比卡因。在恢复室开始使用患者自控镇痛。使用视觉模拟评分法记录疼痛。主要结局是术后住院期间使用的麻醉性镇痛药的量。
我们招募了 50 名患者；其中 25 名接受含肾上腺素的布比卡因，25 名接受脂质体布比卡因。治疗组在年龄、组织学和手术方式方面相似。在住院期间需要的麻醉性镇痛药量（布比卡因 36.3 mg，脂质体布比卡因 38 mg）或手术当天（5 分和 5 分）、第一天（3.5 分和 2.3 分）、第二天（3 分和 2.6 分）、2 周（0 分和 1 分）或 3 个月（0 分和 0 分）的疼痛评估方面，治疗组之间无统计学差异。住院时间和并发症也相似。
在一项小型随机研究中，我们没有发现微创肺切除术后使用含肾上腺素的布比卡因或脂质体布比卡因在缓解疼痛方面有显著差异。在有更多数据可用之前，我们目前倾向于使用较便宜的非脂质体布比卡因制剂。
