布比卡因脂质体胸腔镜引导下肋间神经阻滞对胸腔镜肺叶切除术后镇痛效果的影响

doi:10.3969/j.issn.1006-5725.2026.06.002

Abstract

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

CLC Number:

R614

Shiya LIU,Yixin GUO,Wentong LIU,Hang YIN,Yining CUI,Xihua LU. Evaluation of postoperative analgesic efficacy of liposomal bupivacaine in thoracoscopy-guided intercostal nerve block[J]. The Journal of Practical Medicine, 2026, 42(6): 916-922.

Figures/Tables 7

Fig.1

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

References 33

[1]	CAO W， CHEN H D， YU Y W， et al. Changing profiles of cancer burden worldwide and in China： A secondary analysis of the global cancer statistics 2020［J］. Chin Med J， 2021， 134（7）： 783-791. doi：10.1097/CM9.0000000000001474 . doi: 10.1097/CM9.0000000000001474
[2]	YAN T D， BLACK D， BANNON P G， et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer［J］. J Clin Oncol， 2009， 27（15）： 2553-2562. doi：10.1200/JCO.2008.21.7695 . doi: 10.1200/JCO.2008.21.7695
[3]	MALONEY J， WIE C， PEW S， et al. Post-thoracotomy pain syndrome［J］. Curr Pain Headache Rep， 2022， 26（9）： 677-681. doi：10.1007/s11916-022-01069-z doi: 10.1007/s11916-022-01069-z
[4]	FERGUSON J， TSIM S， KELLY C， et al. Staging by thoracoscopy in potentially radically treatable lung cancer associated with minimal pleural effusion （STRATIFY）： Protocol of a prospective， multicentre， observational study［J］. BMJ Open Respir Res， 2023， 10（1）： e001771. doi：10.1136/bmjresp-2023-001771 . doi: 10.1136/bmjresp-2023-001771
[5]	李月，张伟新，梁汉生，等.胸椎旁神经阻滞对老年胸腔镜肺手术患者术后体温的影响［J］. 实用医学杂志， 2025， 41（14）： 2199-2203. doi：10.3969/j.issn.1671-0800.2025.14.002 . doi: 10.3969/j.issn.1671-0800.2025.14.002
[6]	SUN K， LIU D， CHEN J， et al. Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery： A retrospective study［J］. Sci Rep， 2020， 10（1）： 795. doi：10.1038/s41598-020-57751-y . doi: 10.1038/s41598-020-57751-y
[7]	GUERRA-LONDONO C E， PRIVOROTSKIY A， COZOWICZ C， et al. Assessment of intercostal nerve block analgesia for thoracic surgery： A systematic review and meta-analysis［J］. JAMA Netw Open， 2021， 4（11）： e2133394. doi：10.1001/jamanetworkopen.2021.33394 . doi: 10.1001/jamanetworkopen.2021.33394
[8]	XIAO W， ZHOU W， CHEN X， et al. Analgesic effect of intercostal nerve block given preventively or at the end of operation in video-assisted thoracic surgery： A randomized clinical trial［J］. Braz J Anesthesiol， 2022， 72（5）： 574-578. doi： 0.1016/j.bjane. 2021.07.010 . doi: 0.1016/j.bjane. 2021.07.010
[9]	CHEN H， SONG W， WANG W， et al. Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy： A randomized， double-blind， placebo-controlled trial［J］. BMC Anesthesiol， 2021， 21（1）： 98. doi： 10.1186/s12871-021-01291-z . doi: 10.1186/s12871-021-01291-z
[10]	LI Y， WEI L， DU J H， et al. Comparison of thoracoscopic-guided intercostal nerve block and ultrasound-guided intercostal nerve block in postoperative analgesia of uniportal video-assisted lobectomy： A pilot randomized controlled trial［J］. Int J Surg， 2025， 111（2）： 1995-2001. doi： 10.1097/JS9. 000000000000 2165 . doi: 10.1097/JS9. 000000000000 2165
[11]	马培奇. 美FDA批准布比卡因脂质体注射用悬浮液Exparel治疗术后疼痛［J］. 上海医药， 2012， 33（15）： 29. doi：10.3966/j.issn.1006-1533.2012.15.012 . doi: 10.3966/j.issn.1006-1533.2012.15.012
[12]	SHEETS N W， DAVIS J W， DIRKS R C， et al. Intercostal nerve block with liposomal bupivacaine vs epidural analgesia for the treatment of traumatic rib fracture［J］. J Am Coll Surg， 2020， 231（1）： 150-154. doi： 10.1016/j.jamcollsurg.2019.12.044 . doi: 10.1016/j.jamcollsurg.2019.12.044
[13]	TONG P， GUO Y， WANG Y， et al. Opioid-free anaesthesia protocol based on thoracic paravertebral block enhances postoperative recovery after breast cancer surgery： A two-center， prospective， randomized， controlled trial［J］. J Clin Anesth， 2025， 105： 111904. doi：10.1016/j.jclinane.2025.111904 . doi: 10.1016/j.jclinane.2025.111904
[14]	陈巧辉，苏东风. 罗哌卡因肋间神经阻滞对胸腔镜肺叶切除术后镇痛效果的影响［J］. 外科研究与新技术（中英文）， 2025， 14（1）： 35-38. doi：10.3969/j.issn.2095-378X.2025.01.008 . doi: 10.3969/j.issn.2095-378X.2025.01.008
[15]	SPAANS L N， DIJKGRAAF M G W， SUSA D， et al. Intercostal or paravertebral block vs thoracic epidural in lung surgery： A randomized noninferiority trial［J］. JAMA Surg， 2025， 160（8）： 855-864. doi：10.1001/jamasurg.2025.1899 . doi: 10.1001/jamasurg.2025.1899
[16]	LEE J， LEE D H， KIM S. Serratus anterior plane block versus intercostal nerve block for postoperative analgesic effect after video-assisted thoracoscopic lobectomy： A randomized prospective study［J/OL］. Medicine， 2020， 99（49）： e22102. doi：10.1097/MD.0000000000022102 . doi: 10.1097/MD.0000000000022102
[17]	SPAANS L N， DIJKGRAAF M G W， MEIJER P， et al. Optimal postoperative pain management after VATS lung resection by thoracic epidural analgesia， continuous paravertebral block or single-shot intercostal nerve block （OPtriAL）： Study protocol of a three-arm multicentre randomised controlled trial［J/OL］. BMC Surg， 2022， 22（1）. doi：10.1186/s12893-022-01765-y . doi: 10.1186/s12893-022-01765-y
[18]	史建明，陈乃葆，单靖华，等. 术后胸腔镜直视下、超声引导下INB分别联合PCIA对单孔胸腔镜肺肿物切除术患者的镇痛效果观察［J］. 山东医药， 2024， 64（33）： 63-67. doi：10.3969/j.issn.1002-266X.2024.33.015 . doi: 10.3969/j.issn.1002-266X.2024.33.015
[19]	ANGST M S， DROVER D R. Pharmacology of drugs formulated with DepoFoam： A sustained release drug delivery system for parenteral administration using multivesicular liposome technology［J］. Clin Pharmacokinet， 2006， 45（12）： 1153-1176.doi：10.2165/00003088-200645120-00002 . doi: 10.2165/00003088-200645120-00002
[20]	MANNA S， WU Y， WANG Y， et al. Probing the mechanism of bupivacaine drug release from multivesicular liposomes［J］. J Control Release， 2019， 294： 279-287. doi： 10.1016/j.jconrel.2018.12.029 doi: 10.1016/j.jconrel.2018.12.029
[21]	卢建国，赵香梅，甘绍印，等. 单孔胸腔镜肺部手术应用布比卡因脂质体进行肋间神经阻滞镇痛疗效的前瞻性临床研究［J］. 中国胸心血管外科临床杂志， 2024： 1-6. doi：10.7507/1007-4848.2024.01.001 . doi: 10.7507/1007-4848.2024.01.001
[22]	周岚，黎鹏，宋绍永，等. 超声引导下持续肋间神经阻滞对双孔胸腔镜手术患者术后早期恢复的影响［J］. 临床麻醉学杂志， 2022， 38（6）： 603-607. doi：10.12089/jca.2022.06.009 . doi: 10.12089/jca.2022.06.009
[23]	ADMIRAAL M， MARHOFER P， HOPKINS P M， et al. Peripheral regional anaesthesia and outcomes： A narrative review of the literature from 2013 to 2023［J］. Br J Anaesth， 2024， 132（5）： 1082-1096. doi：10.1016/j.bja.2023.10.013 . doi: 10.1016/j.bja.2023.10.013
[24]	徐亚杰，夏道林，方兆晶，等. 胸椎旁联合肋间神经阻滞对胸腔镜手术女性患者术后反弹性疼痛的影响［J］. 临床麻醉学杂志， 2025， 41（8）： 807-812. doi：10.12089/jca.2025.08.007 . doi: 10.12089/jca.2025.08.007
[25]	沈颖.右美托咪定与地塞米松复合罗哌卡因对胸腔镜直视下肋间神经阻滞效果的影响［D］.上海：上海交通大学，2019.
[26]	LI S， FENG J， FAN K， et al. The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery： A randomized， double-blinded， clinical trial［J］. J Cardiothorac Surg， 2023， 18（1）： 128. doi：10.1186/s13019-023-02210-8 . doi: 10.1186/s13019-023-02210-8
[27]	ZADRAZIL M， MARHOFER P， OPFERMANN P， et al. Liposomal bupivacaine for peripheral nerve blockade： A randomized， controlled， crossover， triple-blinded pharmacodynamic study in volunteers［J］. Anesthesiology， 2024， 141（1）： 24-31. doi：10.1097/ALN.0000000000004988 . doi: 10.1097/ALN.0000000000004988
[28]	HU D， ONEL E， SINGLA N， et al. Pharmacokinetic profile of liposome bupivacaine injection following a single administration at the surgical site［J］. Clin Drug Investig， 2013， 33（2）： 109-115. doi：10.2460/ajvr.25.05.0158 . doi: 10.2460/ajvr.25.05.0158
[29]	HSU D S， ELY S， ALCASID N J， et al. Reduced opioid utilization and post-operative pain in asian vs. Caucasian populations after video-assisted thoracoscopic surgery lobectomy with liposomal bupivacaine-based intercostal nerve blockade［J］. Ann Palliat Med， 2022， 11（5）： 1635-1643. doi： 10.21037/apm-21-2269 . doi: 10.21037/apm-21-2269
[30]	D’ANDRILLI A， RENDINA E A. Enhanced recovery after surgery （ERAS） and fast-track in video-assisted thoracic surgery （VATS） lobectomy： Preoperative optimisation and care-plans［J］. J Vis Surg， 2018， 4： 4. doi：10.21037/jovs.2017.12.17 . doi: 10.21037/jovs.2017.12.17
[31]	BOHANNON R W， CROUCH R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology： A systematic review［J］. J Eval Clin Pract， 2017， 23（2）： 377-381. doi：10.1111/jep.12629 . doi: 10.1111/jep.12629
[32]	SONG W Q， WANG W， YANG Y C， et al. Parasternal intercostal block complementation contributes to postoperative pain relief in modified radical mastectomy employing pectoral nerve block I and serratus-intercostal block： A randomized trial［J］. J Pain Res， 2020， 13： 865-871. doi：10.2147/JPR.S237435 . doi: 10.2147/JPR.S237435
[33]	BENDIXEN M， JØRGENSEN O D， KRONBORG C， et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer： A randomised controlled trial［J］. Lancet Oncol， 2016， 17（6）： 836-844. doi：10.1016/S1470-2045（16）00173-X . doi: 10.1016/S1470-2045（16）00173-X

指标	L组（n = 60）	R组（n = 60）	t/χ² 值	P值
性别/例			0.034	0.853
男	25	26
女	35	34
年龄/岁	59.4 ± 7.6	58.1 ± 8.1	-0.897	0.371
BMI/（kg/m²）	24.1 ± 2.4	23.7 ± 2.5	-0.927	0.356
ASA/例			0.342	0.559
Ⅰ级	21	18
Ⅱ级	39	42
吸烟史/例	25	32	1.637	0.201
手术时间/min	122.7 ± 8.3	124.5 ± 7.9	1.223	0.224
麻醉时间/min	141.1 ± 8.7	143.0 ± 9.2	1.187	0.238
PACU停留时间/min	74.8 ± 25.8	71.6 ± 20.6	0.759	0.449
尿量/mL	401.0 ± 168.0	418.0 ± 170.0	-0.560	0.578
出血量/mL	62.6 ± 30.5	53.3 ± 29.5	-1.700	0.091
补液量/mL	1 419.0 ± 502.0	1 467.0 ± 475.0	-0.540	0.590
手术类型/例			0.362	0.985
左肺上叶	17	18
左肺下叶	14	13
右肺上叶	10	12
右肺中叶	8	7
右肺下叶	11	10

项目	时间	L组（n = 60）	R组（n = 60）	t值	P值
静息时	术后2 h	3.05 ± 1.03	2.83 ± 0.83	1.191	0.236
	术后6 h	3.20 ± 0.55	3.30 ± 0.67	-0.895	0.373
	术后12 h	3.25 ± 0.70	3.75 ± 0.95	-3.275	0.001
	术后24 h	3.70 ± 0.67	4.10 ± 0.89	-2.666	0.009
	术后48 h	3.05 ± 0.67	3.60 ± 0.89	-3.823	< 0.001
	术后72 h	1.28 ± 0.87	1.58 ± 0.70	-2.092	0.039
活动时	术后2 h	3.22 ± 0.80	2.97 ± 0.78	1.728	0.087
	术后6 h	3.57 ± 0.69	3.70 ± 0.87	-0.926	0.356
	术后12 h	3.78 ± 1.50	4.52 ± 1.42	-2.753	0.007
	术后24 h	3.80 ± 1.04	5.07 ± 2.23	-3.987	< 0.001
	术后48 h	3.45 ± 0.89	4.25 ± 1.48	-3.587	< 0.001
	术后72 h	1.87 ± 0.87	1.95 ± 0.96	-0.496	0.621

项目	L组（n = 60）	R组（n = 60）	t/χ²/Z值	P值
舒芬太尼总消耗量/μg	56.5 ± 9.1	77.1 ± 13.8	9.675	< 0.001
镇痛泵首次按压时间［M（P₂₅，P₇₅）］/h	8.0（6.0，9.0）	6.0（5.0，8.0）	-3.261	0.001
补救镇痛/［例（%）］	8（13.33）	19（31.67）	5.783	0.016
首次下床时间/h	24.6 ± 3.0	31.1 ± 3.8	10.396	0.001
引流管留置时间/h	71.8 ± 2.5	72.5 ± 3.5	1.129	0.261

时间	L组（n = 60）	R组（n = 60）	Z值	P值
0~ 24 h	3.0（2.0，4.0）	6.0（4.0，6.0）	-6.581	< 0.001
24 ~ 48 h	5.0（4.0，7.0）	10.0（8.0，11.0）	-8.345	< 0.001
48 ~ 72 h	3.0（2.0，4.0）	4.0（3.0，4.0）	-2.261	0.024

时间	L组（n = 60）	R组（n = 60）	t值	P值
术前	137.8 ± 5.9	139.3 ± 6.04	-1.398	0.165
术后24 h	112.2 ± 2.6	101.0 ± 5.8	-13.626	0.001
术后72 h	134.4 ± 4.4	132.7 ± 3.9	2.127	0.036

Evaluation of postoperative analgesic efficacy of liposomal bupivacaine in thoracoscopy-guided intercostal nerve block

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 33

Related Articles 13

Recommended Articles

Metrics

Comments

项目	L组（n = 60）	R组（n = 60）	χ² 值	P值
恶心呕吐	6（10.00）	16（26.67）	5.570	0.018
头晕	1（1.67）	3（5.00）	0.259	0.611
嗜睡	2（3.33）	3（5.00）	-	-
咳嗽无力	1（1.67）	2（3.33）	-	-
肺部感染	1（1.67）	1（1.67）	-	-
肺不张	0（0.00）	1（1.67）	-	-
血肿	0（0.00）	0（0.00）	-	-
神经损伤	0（0.00）	0（0.00）	-	-
总体不良反应	11（18.33）	26（43.33）	8.937	0.003

[1]	Hongxia WU,Fei JIANG,Chuan LUO,Xingcong ZHANG,Yihua WANG,Yong YANG. The effect of different concentrations of ropivacaine on the postoperative analgesic effect and stress response in patients undergoing laparoscopic total hysterectomy by blocking the lumbosacral muscle of the arcuate ligament [J]. The Journal of Practical Medicine, 2026, 42(6): 1051-1056.
[2]	Tianxiao DU,Caifen LI,Yu ZHANG,Luming DAI,Qiuxiang JIANG,Hanqing QU,Yang LU,Zheng GONG. Effect of superficial cervical plexus block with ropivacaine or combined with adjuvants on patients undergoing radical thyroid cancer surgery [J]. The Journal of Practical Medicine, 2026, 42(3): 517-524.
[3]	Lixia WEN,Duan GAO,Xiaobing ZHU,Zhiyi CHEN,Xueqiang PENG,Yanyan DU,Xianbao LIU. Analgesic efficacy of the infraspinatus-teres minor interfascial block for arthroscopic shoulder surgery [J]. The Journal of Practical Medicine, 2026, 42(1): 132-138.
[4]	Xin LI,Meng WANG,Xiaodong CHEN,Hao HUA,Tongsheng XU,Ye WANG. Effect of esketamine combined with pericapsular nerve block of the hip joint on stress response and postoperative analgesic effect in elderly patients undergoing total hip arthroplasty [J]. The Journal of Practical Medicine, 2025, 41(22): 3590-3597.
[5]	Chenglong LI,Lun WAN,Lisha HUANG,Yucheng ZHAN,Shiying LONG,Zheng. WANG. Effect of intrathecal morphine combined with liposomal bupivacaine adductor canal block on postoperative analgesia and opioid⁃sparing effect in patients undergoing total knee arthroplasty [J]. The Journal of Practical Medicine, 2025, 41(19): 3083-3088.
[6]	Xiaohua GUO,Qian CHEN,Qing ZHAO,Xinying GUO,Yongying PAN,Wanqing JI,Yulin JIN. Efficacy and safety of liposomal bupivacaine in transversus abdominis plane block for post⁃cesarean analgesia [J]. The Journal of Practical Medicine, 2025, 41(11): 1724-1729.
[7]	Jianqiang ZENG,Zhaoying ZHONG,Lei YUAN,Donglan. PENG. Effects of different doses of dexmedetomidine combined with ropivacaine TPVB under ultrasound guidance on vital signs and stress response of patients undergoing thoracoscopic surgery under general anesthesia [J]. The Journal of Practical Medicine, 2024, 40(24): 3527-3533.
[8]	Guojiang YIN,Bixi LI,Pengxiao WEI,Yuqin YAN,Xiaoyang SONG,Kun LI. Effect of anterior quadratus lumborum block at the lateral supra⁃arcuate ligament on postoperative analgesia and inflammatory response in elderly patients undergoing robot⁃assisted radical prostatectomy [J]. The Journal of Practical Medicine, 2024, 40(2): 202-206.
[9]	MAO Ye, ZHAO Wei, HAO Mengxiao, XING Rui, YAN Ming.. Comparison of quadratus lumborum block at the lateral supra⁃arcuate ligament and subcostal transversus abdominis plane block on postoperative pain and recovery quality after open partial hepatectomy [J]. The Journal of Practical Medicine, 2023, 39(9): 1111-1117.
[10]	WANG Xin, WANG Lu. Xuzhou . Analgesic effect of ropivacaine transverse abdominal muscle plane block combined with PCIA after exter⁃ nal abdominal hernia surgery [J]. The Journal of Practical Medicine, 2022, 38(24): 3141-3144.
[11]	LENG Shize , ZHANG Hui.. Research progress of intraperitoneal administration of ropivacaine for enhanced recovery after laparoscopic surgery [J]. The Journal of Practical Medicine, 2022, 38(24): 3162-3166.
[12]	YUAN Binglin, HUANG Xiqiang, LI Bingfei, HUANG Huansen.. The postoperative analgesia effects of different doses of Dexmedetomidine with ropivacaine in thoracic paravertebral block for modified radical mastectomy in breast cancer [J]. The Journal of Practical Medicine, 2021, 37(3): 374-378.
[13]	WEI Shunmin, SUN Xude.. Clinical effect of hydromorphone and oxycodone in patient⁃controlled intravenous analgesia after thoraco⁃ scopic radical resection of lung cancer [J]. The Journal of Practical Medicine, 2021, 37(22): 2908-2913.