Efficacy and Safety of Bupivacaine Liposomal in Intercostal Nerve Block for Postoperative Pain Management Following Uniportal Thoracoscopy: A Randomized Trial

Background: Postoperative pain in thoracic surgery often requires opioids, yet can be poorly managed with short-acting anesthetics. Liposomal bupivacaine (LB) offers prolonged analgesia, potentially improving pain control and reducing opioid use. This study evaluates LB's effectiveness and safety in thoracic postoperative pain management, aiming to provide an alternative to current practices. Methods: In this single-center, double-blind, prospective, randomized controlled trial, patients undergoing uniportal lobectomy, segmentectomy, or wedge resection from November 2023 to May 2024 were enrolled. Participants were randomly assigned in a 1:1 ratio to receive either 0.375% ropivacaine (control group, n = 57) or LB (LB group, n = 56) for intercostal nerve blocks (ICNBs). Postoperative visual analog scale (VAS) scores, opioid consumption, overall benefit of analgesia score (OBAS), chest tube duration, length of hospital stay, and adverse events (AEs) were recorded and analyzed. Results: Data from 57 patients in the control group and 56 patients in the LB group were included in the analysis, with no significant demographic differences between the groups. The LB group demonstrated lower VAS scores at rest and during activity (p > 0.05), reduced opioid consumption (p=0.021), and higher OBAS (p < 0.01) compared with the control group. No significant differences were observed in chest tube duration, length of hospital stay, or AEs between the groups. Conclusion: LB is safe and effective for ICNB, providing significant postoperative pain relief for patients undergoing uniportal thoracoscopic surgery. Trial Registration: Chinese Registry of Clinical Trials: chiCTR2300075463.