Liposomal bupivacaine intercostal block placed under direct vision reduces morphine use in thoracic surgery

Anupama Singh; Miles McAllister; Luis E De León; Suden Kücükak; Matthew M Rochefort; Emanuele Mazzola; Luisa Maldonado; Phillip M Hartigan; Michael T Jaklitsch; Scott J Swanson; Raphael Bueno; Ashley L Deeb; Namrata Patil

doi:10.21037/jtd-23-1405

Liposomal bupivacaine intercostal block placed under direct vision reduces morphine use in thoracic surgery

J Thorac Dis. 2024 Feb 29;16(2):1161-1170. doi: 10.21037/jtd-23-1405. Epub 2024 Feb 23.

Affiliations

¹ Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
² Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.

Abstract

Background: Thoracic epidural analgesia (TEA) and liposomal bupivacaine (LB) are two methods used for postoperative pain control after thoracic surgery. Some studies have compared LB to standard bupivacaine. However, data comparing the outcomes of LB to TEA after minimally invasive lung resection is limited. Therefore, the objective of our study was to compare postoperative pain, opioid usage, and outcomes between patients who received TEA vs. LB.

Methods: We conducted a retrospective chart review of patients who underwent minimally invasive lung resections over an 8-month period. Intraoperatively, patients received either LB under direct vision or a TEA. Pain scores were obtained in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. Morphine milligram equivalents (MMEs) were calculated at 24 and 48 hours postoperatively. Postoperative outcomes were then compared between groups.

Results: In total, 391 patients underwent minimally invasive lung resection: 236 (60%) wedge resections, 51 (13%) segmentectomies, and 104 (27%) lobectomies. Of these, 326 (83%) received LB intraoperatively. Fewer patients in the LB group experienced postoperative complications (18% vs. 34%, P=0.004). LB patients also had lower median pain scores at 24 (P=0.03) and 48 hours (P=0.001) postoperatively. There was no difference in MMEs at 24 hours (P=0.49). However, at 48 hours, patients who received LB required less narcotics (P=0.02). Median hospital length of stay (LOS) was significantly shorter in patients who received LB (2 vs. 4 days, P<0.001). On multivariable analysis, increasing age, postoperative complications, and use of TEA were independently associated with a longer hospital LOS.

Conclusions: Compared to TEA, LB intercostal block placed under direct vision reduced morphine use 48 hours after thoracic surgery. It was also associated with fewer postoperative complications and shorter median hospital LOS. LB is a good alternative to TEA for pain management after minimally invasive lung resection.

Keywords: Liposomal bupivacaine (LB); epidural; postoperative pain after thoracic surgery.