Yang Zhen, Liu Manman, Wang Chengyu, Song Yuejiao, Wu Junmei, Wu Dan, Yao Minmin, Yang Yan, Miao Changhong, Liang Chao
Department of Anesthesiology, Xiamen Zhongshan Hospital, Fudan University, Xiamen, Fujian, People's Republic of China.
Department of Anesthesiology, Shanghai Geriatric Medical Center, Fudan University, Shanghai, People's Republic of China.
Drug Des Devel Ther. 2025 Aug 12;19:6955-6964. doi: 10.2147/DDDT.S532122. eCollection 2025.
The effectiveness of a thoracic paravertebral blockade with liposomal bupivacaine for thoracic surgery pain management is not well examined. This study compared the effects of liposomal bupivacaine and plain bupivacaine on a thoracic paravertebral blockade in adult patients undergoing video-assisted thoracoscopic surgery (VATS).
Consenting participants (114) scheduled for VATS were randomly assigned to thoracic paravertebral blockade at T4-5 and T7-8 levels with 20 mL (266 mg) liposomal bupivacaine (LB) or 20 mL (37.5 mg) plain bupivacaine (PB) groups. The primary endpoint was opioid consumption at 48 hours postoperatively. Additional main outcomes included the opioid consumption 24 and 72 hours postoperatively; the pain score at rest and coughing 24, 48, and 72 hours postoperatively; Quality of Recovery-15 (QoR-15) scores 24 hours postoperatively, the time to the first analgesia request.
Opioid consumption did not differ between the groups at 48 hours postoperatively. The QoR-15 scores 24 hours after surgery were higher in the LB group than in the PB group (mean [SD], 120.2 [7.1] vs 116.5 [7.8]; P = 0.009). The time to the first analgesia request was longer in the LB group than in the PB group (mean [SD], 585.8min [211.7] vs 315.3min [101.7]; P <0.001). The areas under the curve for the NRS score at rest were 21.2 and 35.8 for the LB and PB groups, respectively (P = 0.002). The NRS scores during coughing did not differ between the two groups, nor did the CPSP three months postoperatively.
Liposomal bupivacaine offers limited but measurable clinical benefits when used for thoracic paravertebral blockade in patients undergoing VATS.
Chinese Clinical Trial Registry; Registration number: ChiCTR2400081544, URL: https://www.chictr.org.cn/showproj.html?proj=221025.
脂质体布比卡因用于胸段椎旁阻滞以管理胸科手术疼痛的有效性尚未得到充分研究。本研究比较了脂质体布比卡因和普通布比卡因对接受电视辅助胸腔镜手术（VATS）的成年患者胸段椎旁阻滞的效果。
计划接受VATS的114名同意参与的参与者被随机分配至在T4 - 5和T7 - 8水平接受20 mL（266 mg）脂质体布比卡因（LB）或20 mL（37.5 mg）普通布比卡因（PB）组的胸段椎旁阻滞。主要终点是术后48小时的阿片类药物消耗量。其他主要结局包括术后24小时和72小时的阿片类药物消耗量；术后24、48和72小时静息和咳嗽时的疼痛评分；术后24小时的恢复质量-15（QoR-15）评分，首次镇痛请求的时间。
术后48小时两组间阿片类药物消耗量无差异。LB组术后24小时的QoR-15评分高于PB组（均值[标准差]，120.2[7.1]对116.5[7.8]；P = 0.009）。LB组首次镇痛请求的时间长于PB组（均值[标准差]，585.8分钟[211.7]对315.3分钟[101.7]；P <0.001）。LB组和PB组静息时NRS评分的曲线下面积分别为21.2和35.8（P = 0.002）。两组咳嗽时的NRS评分无差异，术后三个月的慢性术后疼痛（CPSP）也无差异。
脂质体布比卡因用于接受VATS患者的胸段椎旁阻滞时提供了有限但可测量的临床益处。
中国临床试验注册中心；注册号：ChiCTR2400081544，网址：https://www.chictr.org.cn/showproj.html?proj=221025 。
