Jia-Yi Zhao, Di Fan, Shu-Yao Zhu, Jian-Hua Tong, Ying Li, Qing-Ren Liu
Compared with bupivacaine plus dexamethasone, liposomal bupivacaine for RISS block in thoracoscopic lobectomy did not improve postoperative analgesia or reduce oxycodone consumption. Moreover, although liposomal bupivacaine prolonged the duration of analgesia, the clinical benefit was limited.
BACKGROUND: Liposomal bupivacaine may prolong analgesia in regional anesthesia; however, its effectiveness in fascial plane blocks remains uncertain. This study compared liposomal bupivacaine plus bupivacaine with bupivacaine plus dexamethasone for rhomboid intercostal and sub-serratus (RISS) plane block for postoperative analgesia following thoracoscopic lobectomy.
METHODS: In this randomized, double-blind, parallel-group trial, 78 patients undergoing thoracoscopic lobectomy were randomly assigned (1:1) to receive either liposomal bupivacaine plus bupivacaine (LB group, n = 39) or bupivacaine plus dexamethasone (BD group, n = 39) for RISS block. The primary outcome was the area under the curve (AUC) of resting Numeric Rating Scale (NRS) pain scores over 72 h postoperatively. Secondary outcomes included the AUC for cough NRS scores within 72 h postoperatively, NRS scores at 72 h postoperatively, duration of analgesia, cumulative oxycodone consumption postoperatively, and the incidence of adverse effects.
RESULTS: The AUC of resting NRS pain scores over 72 h postoperatively was comparable between the LB and BD groups (110.8 ± 15.6 vs 113.4 ± 19.9 score·h; MD = 2.551, 95% CI -14.57 ~ 19.68, P = 0.767). Similarly, no significant between-group differences were observed in the AUC of coughing pain scores (176.1 ± 17.4 vs 180.9 ± 18.4 score·h; MD = 4.795, 95% CI -12.04 ~ 21.63, P = 0.572). The duration of analgesia was significantly longer in the LB group than in the BD group (381.2 ± 101.6 vs 323.5 ± 95.3 min; MD = 57.7, 95% CI 13.27 ~ 102.13, P = 0.011). However, cumulative oxycodone consumption and postoperative pain scores at all assessment time points were comparable between groups. The incidence of adverse events was similar in both groups.
CONCLUSION: Compared with bupivacaine plus dexamethasone, liposomal bupivacaine for RISS block in thoracoscopic lobectomy did not improve postoperative analgesia or reduce oxycodone consumption. Moreover, although liposomal bupivacaine prolonged the duration of analgesia, the clinical benefit was limited.