目的 比较布比卡因脂质体与罗哌卡因在胸腔镜引导下肋间神经阻滞（TINB）中对胸腔镜肺叶切除术（VATS）患者术后镇痛效果及恢复质量的影响。 方法 纳入2025年1—6月拟行全麻下VATS患者120例，随机分为布比卡因脂质体L组（266 mg/20 mL，n = 60）和罗哌卡因 R组（100 mg/20 mL，n = 60）。两组均在胸腔镜直视下行T₄—T₈ INB，术后接受72 h自控静脉镇痛（PCIA）。记录术后2、6、12、24、48、72 h 静息及活动时NRS评分。记录舒芬太尼总消耗量、PCIA首次按压时间、补救镇痛率，术后首次下床时间、胸腔引流管的留置时间，记录术后72 h PCIA有效按压次数，术前24 h及术后24、72 h 的恢复质量评分（QoR-15），记录术后恶心呕吐、肺部并发症及INB相关不良反应的发生率。 结果 与R组比较，L组术后12、24、48、72 h 静息时NRS评分及 12、24、48 h活动时NRS 评分明显降低，舒芬太尼总消耗量明显减少、PCIA 首次按压时间明显延长、首次下床时间明显缩短、补救镇痛率明显减少，术后0 ~ 24、24 ~ 48及48 ~ 72 h PCIA 有效按压次数均明显减少，术后24、72 h QoR?15评分明显升高（P < 0.05），恶心呕吐发生率明显降低（P < 0.05）。两组胸腔引流管的留置时间、肺部并发症等相关不良反应发生率差异均无统计学意义（P > 0.05），两组患者均未发生神经阻滞相关并发症。 结论 布比卡因脂质体TINB可实现72 h持续镇痛，显著减少阿片类药物用量并能提高患者早期恢复质量，不良反应较少，是VATS术后镇痛的优化选择。

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.