Effect of Liposomal Bupivacaine for Intercostal Nerve Block on Chronic Postoperative Pain Following Video-Assisted...

Chronic postsurgical pain (CPSP) is a common complication of video-assisted thoracoscopic surgery (VATS) and substantially impairs postoperative quality of life. We evaluated whether intercostal nerve block (ICNB) with liposomal bupivacaine provides superior chronic pain control compared with ropivacaine.

We conducted a retrospective cohort study of 1325 adult patients who underwent elective VATS lung resection with ICNB administered using either liposomal bupivacaine or ropivacaine at the end of the surgery between September 2023 and August 2024. The primary outcome was the incidence of CPSP at 3 months postoperatively, defined as a numerical rating scale (NRS) pain score ≥1, a sensitive threshold to capture any postoperative pain. Secondary outcomes included NRS pain scores at rest at 24 and 48 hours postoperatively, cumulative opioid consumption within 48 hours, time to independent postoperative activities, length of hospital stay, and incidence of postoperative neuropathic pain at 3 months. Confounding was addressed using 1:1 propensity score matching with a 0.1 standard deviation caliper.

The median age was 61 years, and 59.9% were female. After propensity score matching, ICNB with liposomal bupivacaine was associated with a significantly lower incidence of CPSP at 3 months compared with ropivacaine (33.5% vs 42.3%; adjusted odds ratio, 0.68; 95% CI, 0.52 to 0.88; P=0.004). Patients receiving liposomal bupivacaine had reduced rest NRS pain scores at both 24 hours (3[2, 4] vs 4[3, 4]; P=0.002) and 48 hours (3[2, 3] vs 3[2, 4]; P=0.038). No significant differences were observed in other secondary outcomes.

ICNB with liposomal bupivacaine was associated with reduced incidence of CPSP following VATS lung resection. These findings highlight the potential long-term analgesic benefit of liposomal bupivacaine and support the need for further randomised controlled trials evaluating long-term CPSP outcomes.