目的 评估在接受胸腔镜肺切除（VATS）手术的患者中，经胸腔镜直视下肋间神经阻滞（INB）给予布比卡因脂质体（LB）与罗哌卡因（RO）相比的镇痛效果和安全性。 方法 在这项随机、双盲、平行对照试验中，计划行VATS的患者被随机分配在关胸前接受胸腔镜直视下INB，LB组和RO组分别给予LB（133 mg/10 mL）或RO（75 mg/10 mL），经胸膜在手术切口及其上下两个肋间，分别注射2 mL药液，剩余药液进行切口浸润。主要结局指标为术后72 h内中重度疼痛的发生率。次要结局指标包括爆发痛的发生率、多个时间点的疼痛评分和其他恢复指标。 结果 最终纳入意向性治疗（ITT）分析的患者共80例（LB组40例，RO组40例）。LB组术后72 h内中重度疼痛的发生率显著低于RO组（20% vs. 42.5%，P = 0.030）。LB组的爆发痛发生率也显著降低（17.5% vs. 37.5%，P = 0.045）。作为敏感性分析的符合方案（PP）分析（LB组34例，RO组35例），结果与ITT分析一致，两组恢复指标或不良事件发生率均无显著差异。 结论 给予LB经直视下INB可显著降低胸腔镜肺部手术术后中重度疼痛和爆发痛的发生率。LB具有独特的“削峰”效应，可提高术后早期舒适度，是胸外科多模式镇痛的重要组成部分。

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.