Author: Wei Y et al.
Journal of Cardiothoracic and Vascular Anesthesia, 2025. doi:10.1016/j.accpm.2025.101591
This randomized controlled trial compared liposomal bupivacaine (LB) with ropivacaine for thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lung resection. Sixty patients were enrolled.
LB provided pain control comparable to ropivacaine in the early postoperative phase but offered significant delayed benefits. At 72 hours, patients receiving LB had lower cough-related pain scores, reduced sufentanil use, fewer PCA demands, and lower chronic pain scores at 1–3 months. These effects align with ERAS goals by minimizing opioid exposure. However, LB was linked to a higher incidence of postoperative nausea and vomiting (PONV). No major differences were found in rest pain, recovery quality, or other complications.
Despite its high cost (≈30× ropivacaine), LB’s delayed analgesic and opioid-sparing advantages may justify use in high-risk surgical populations if paired with antiemetic strategies and supported by formal cost-effectiveness analyses.
What You Should Know
• Early analgesia: Comparable to ropivacaine within the first 24 hours.
• Delayed benefit: Better cough-related pain control at 72 hours and lower chronic pain scores up to 3 months.
• Opioid-sparing: Significantly reduced sufentanil use and PCA demands from 12–72 hours.
• Trade-off: Higher rates of PONV.
• Cost: Thirtyfold more expensive—cost-effectiveness must be carefully evaluated.
• Implication: May be best reserved for high-risk cohorts where long-term benefits outweigh expense.
Thank you to the Journal of Cardiothoracic and Vascular Anesthesia for making this work available.