关键词: 布比卡因脂质体, 罗哌卡因, 肋间神经阻滞, 术后镇痛, 胸腔镜下肺叶切除术

Abstract:

Objective To compare the effects of liposomal bupivacaine and ropivacaine in thoracoscopy-guided intercostal nerve block （TINB） on postoperative analgesia and recovery quality in patients undergoing video-assisted thoracoscopic lobectomy （VATS）. Methods A total of 120 patients who were scheduled for VATS lobectomy under general anesthesia from January to June 2025 were recruited and randomly allocated into the liposomal bupivacaine group （Group L， 266 mg/20 mL， n = 60） and the ropivacaine group （Group R， 100 mg/20 mL， n = 60）. In both groups， thoracic intercostal nerve block （INB） at the T₄—T₈ level was performed under direct thoracoscopic visualization， followed by 72-hour patient-controlled intravenous analgesia （PCIA）. The resting and activity Numeric Rating Scale （NRS） scores at 2， 6， 12， 24， 48， and 72 hours post-surgery were recorded. The total sufentanil consumption， the time to the first PCIA demand， the rescue analgesia rate， the time to the first ambulation， the duration of chest tube placement， the total effective PCIA presses within 72 hours， the Quality of Recovery-15 （QoR-15） scores at 24 hours before surgery and 24/72 hours after surgery， as well as the incidences of nausea/vomiting， pulmonary complications， and INB-related adverse events were documented. Results Compared with Group R， Group L exhibited significantly lower resting NRS scores at 12， 24， 48， and 72 h and activity NRS scores at 12， 24， and 48 h （P < 0.05）. Additionally， it showed significantly reduced total sufentanil consumption， a prolonged time to the first PCIA demand， a shorter time to the first ambulation， a reduced rescue analgesia rate， decreased effective PCIA presses during the 0 ~ 24， 24 ~ 48， and 48 ~ 72 h intervals （P < 0.05）， higher QoR-15 scores at 24/72 h （P < 0.05）， and a significantly lower nausea/vomiting incidence （P < 0.05）. There were no inter-group differences in the chest tube duration or the incidences of pulmonary complications and other adverse events （P > 0.05）. Moreover， neither group encountered nerve block-related complications. Conclusion Liposomal bupivacaine TINB offers 72-hour prolonged analgesia， significantly decreases opioid consumption， improves the quality of early recovery with fewer adverse effects， and thus represents an optimized option for postoperative analgesia in VATS.

Key words: liposomal bupivacaine, ropivacaine, intercostal nerve block, postoperative analgesia, video-assisted thoracoscopic lobectomy