关键词: 胸腔镜手术, 布比卡因脂质体, 肋间神经阻滞, 术后疼痛, 多模式镇痛

Abstract:

Objective This study assessed the analgesic efficacy and safety of liposomal bupivacaine （LB） delivered through direct-vision intercostal nerve block （INB） in comparison with ropivacaine （RO） among patients undergoing Video-assisted thoracoscopic surgery （VATS）. Methods In this randomized， double-blind， parallel-controlled trial， patients scheduled for VATS were randomly assigned to receive thoracoscopic video-assisted INB prior to chest closure. They were divided into two groups： the liposomal bupivacaine group （LB group， 133 mg/10 mL） and the ropivacaine group （RO group， 75 mg/10 mL）. Under direct thoracoscopic vision， 2 mL of the solution was injected transpleurally at the surgical incision level and the adjacent upper and lower intercostal spaces respectively. The remaining solution was used for local wound infiltration. The primary outcome was the incidence of moderate-to-severe pain within 72 hours post-operation. Secondary outcomes included the incidence of breakthrough pain， pain scores at multiple time points， and recovery indicators. Results A total of 80 patients were incorporated into the final intention-to-treat （ITT） analysis （LB group， n = 40； RO group， n = 40）. The incidence of moderate-to-severe pain within 72 h was notably lower in the LB group compared to the RO group （20% vs. 42.5%， P = 0.030）. The incidence of breakthrough pain was also remarkably reduced in the LB group （17.5% vs. 37.5%， P = 0.045）. The per-protocol （PP） analysis （LB group， n = 34； RO group， n = 35）， which functioned as a sensitivity analysis， produced results that were completely consistent with the ITT analysis. No significant disparities were detected in recovery indicators or the incidence of adverse events between the two groups. Conclusions LB administered via direct-vision INB significantly reduces the incidence of moderate-to-severe and breakthrough pain after VATS. By exhibiting a unique “shaving the peak” effect， LB improves early postoperative comfort with a favorable safety profile and serves as a valuable component of multimodal analgesia for thoracic surgery.

Key words: video-assisted thoracoscopic surgery, liposomal bupivacaine, intercostal nerve block, postoperative pain, multimodal analgesia