Liposomal Bupivacaine Combined with Bupivacaine vs Ropivacaine for Paravertebral Blockade in Single-Port Video-Assisted Thoracoscopic Surgery: A Propensity-Matched Comparison of Postoperative Opioid Use.

Abstract

Objective: To compare the effect of preoperative single-injection paravertebral block using liposomal bupivacaine/bupivacaine mixture versus ropivacaine on cumulative postoperative opioid consumption in patients undergoing thoracic surgery.

Methods: This retrospective cohort study included adult patients who underwent elective single-port video-assisted thoracoscopic surgery (wedge resection, segmentectomy, or lobectomy) between January 2024 and February 2026. Patients received an ultrasound-guided single-injection paravertebral block with either 0.5% ropivacaine (20 mL) or a mixture of 1.3% liposomal bupivacaine (10 mL) and 0.5% standard bupivacaine (10 mL). The primary outcome was cumulative postoperative opioid consumption throughout the hospitalization, delivered via patient-controlled analgesia (PCA) and converted to oral morphine milligram equivalents. Secondary outcomes included pain scores, time to first PCA request, postoperative adverse events, and length of stay. Propensity score matching (1:2) was performed to balance baseline clinical and intraoperative characteristics.

Results: Among 492 eligible patients, 331 received ropivacaine and 161 received liposomal bupivacaine/bupivacaine combination. After matching, 210 and 108 patients were included in the ropivacaine and liposomal bupivacaine groups, respectively. The median cumulative postoperative opioid consumption was lower in the liposomal bupivacaine group (92.1 mg [IQR, 59.1-122.3]) than in the ropivacaine group (226.2 mg [IQR, 170.2-260.0]), with a median difference of 128.2 mg (95% CI, 111.0-143.9; P < 0.001). The liposomal bupivacaine group was also associated with lower resting and movement pain scores at 24 and 48 hours postoperatively, a longer time to first PCA press (26.0 vs. 6.0 hours; P < 0.001), and a lower incidence of postoperative dizziness (21.3% vs. 34.3%; P = 0.017).

Conclusion: For patients undergoing video-assisted thoracoscopic surgery, preoperative single-injection paravertebral blockade with liposomal bupivacaine/bupivacaine mixture was associated with lower cumulative postoperative opioid consumption and lower early postoperative pain scores than ropivacaine.