Ultrasound-Guided Thoracic Paravertebral Block With Liposomal Versus Standard Bupivacaine for Older Patients After...

The study aimed to investigate the effect of thoracic paravertebral block (TPVB) with liposomal bupivacaine (LB) before anesthesia induction on postoperative pain, quality of recovery (QoR), and opioid consumption in older patients after video-assisted thoracoscopic surgery (VATS). A total of 116 older patients who were scheduled to undergo VATS were allocated into a SB group (TPVB with standard bupivacaine [SB] before anesthesia induction) and a LB group (TPVB with LB before anesthesia induction). The primary outcome was the Numerical Rating Scale (NRS) scores of patients measured at 6, 12, 24, 36, 48, and 72 h postoperatively. The secondary outcomes were score of the QoR-15 questionnaire at 24 h postoperatively, effective times of patient-controlled intravenous analgesia (PCIA), cumulative sufentanil consumption, first time to request for analgesia, incidence of adverse events, and incidence of postoperative delirium. The LB group had significantly lower NRS scores at 24 and 36 h postoperatively than those in the SB group. The LB group exhibited significantly higher QoR-15 scores at 24 h postoperatively, fewer effective times of PCIA, less cumulative sufentanil consumption from 24 to 72 h postoperatively, and longer time to first request for analgesia than the SB group. The two groups did not differ in incidences of adverse events and postoperative delirium. The study provides evidence that TPVB with LB is effective in alleviating postoperative pain at 24 and 36 h postoperatively, improving QoR, and providing opioid savings for older patients after VATS.