Effect of liposomal bupivacaine thoracic paravertebral block on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled trial

Background Thoracic paravertebral block (TPVB) can provide effective analgesia for patients undergoing video-assisted thoracoscopic surgery (VATS). However, the duration of analgesia achieved with conventional local anesthetics combined with dexamethasone remains limited. This study aimed to determine if liposomal bupivacaine (LB) is superior to bupivacaine combined with dexamethasone (BD) with respect to duration of postoperative analgesia in VATS patients. Methods Adults scheduled for VATS were randomized to treatment with LB or BD. The primary outcome was duration of analgesia. Secondary outcomes involved Numeric Rating Scale (NRS) pain scores, cumulative oxycodone consumption, total intraoperative sufentanil consumption, first times to ambulation and flatus, length of hospital stay, patient satisfaction level, and incidence of adverse reactions. Results Of 93 total subjects, 78 were randomized into two groups (n=39 each). The LB group demonstrated a significantly prolonged duration of analgesia compared with the BD group (1160.4±403.8 min vs 743.1±216.8 min, p<0.001), with a mean increase of 417 min (a 56% extension). LB was associated with lower resting and cough NRS pain scores on the first postoperative day. The 72-hour area under the curve values for scores for resting pain (67.5 vs 87.9) and pain during cough (213.9 vs 244.0) were lower for the LB group versus the BD group. In exploratory analyses, cumulative oxycodone consumption on the first postoperative day was numerically lower in the LB group. Subjects receiving treatment LB had lower cumulative oxycodone consumption on the first postoperative day, earlier times to first ambulation and first flatus, and higher satisfaction scores as compared with subjects receiving BD. There was no significant difference between the two groups in terms of total intraoperative sufentanil consumption, duration of hospital stay, or incidence of adverse events. Conclusion In VATS patients receiving TPVB, LB significantly prolonged the duration of postoperative analgesia compared with BD. Exploratory secondary outcomes suggested modest improvements in early pain profiles and potential opioid-sparing and early recovery benefits. Trial registration number ChiCTR2500095090.