Liposomal Bupivacaine Versus Ropivacaine in Combined Thoracic Paravertebral Block and Serratus Anterior Plane Block for Thoracoscopic Surgery: A Randomized Controlled Trial

The study aimed to compare the use of liposomal bupivacaine (LB) and ropivacaine hydrochloride (RH) in combined thoracic paravertebral block (TPVB) and serratus anterior plane block (SAPB) during video-assisted thoracoscopic surgery (VATS). The primary outcome was cumulative consumption of 72-h morphine milligram equivalent (MME) postoperatively. The secondary outcomes were MME consumption at 0-24 h, 24-48 h, and 48-72 h postoperatively, scores of visual analogue scale (VAS) at 6, 12, 24, 48, and 72 h postoperatively, effective times of patient-controlled intravenous analgesia (PCIA), and first time to request for analgesia. The LB-TPVB-SAPB group (n = 66) exhibited a decrease in total MME consumption within 72 h postoperatively compared to the RH-TPVB-SAPB group (n = 66) [independent t-test: p < 0.0001, Cohen's d = -1.05; mean difference with 95% confidence interval: -14.02 (-18.68 to -9.35)]. Bonferroni multiple comparisons test after repeated-measures ANOVA showed less MME consumption at 0-24 h (p < 0.001) and 24-48 h (p = 0.013) with lower VAS scores at 24 (p < 0.001) and 48 h (p = 0.002) postoperatively in the LB-TPVB-SAPB group than the RH-TPVB-SAPB group. Fewer effective times of PCIA and longer time to first request for analgesia were also observed in the LB-TPVB-SAPB group than the RH-TPVB-SAPB group. In conclusion, this study demonstrates LB in combined TPVB and SAPB could reduce postoperative opioid consumption compared to RH in this combination after VATS and the absolute change in postoperative opioid consumption exceeds the reported minimal clinically important difference.