Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†.
The purpose of this research is to compare liposomal bupivacaine and bupivacaine/epinephrine for intercostal blocks related to analgesic use and length of stay following video-assisted thoracoscopic wedge resection.



A retrospective study of patients undergoing video-assisted thoracoscopic wedge resection from 2010 to 2015 was performed. We selected patients who stayed longer than 24 h in hospital. Primary outcomes were length of stay and postoperative analgesic use at 12-h intervals from 24 to 72 h.



Intercostal blocks were performed with liposomal bupivacaine in 62 patients and bupivacaine/epinephrine in 51 patients. A Wilcoxon signed-rank test evaluated differences in median postoperative analgesic use and length of stay. Those who received liposomal bupivacaine consumed fewer analgesics than those who received bupivacaine/epinephrine, with a statistically significant difference from 24 to 36 h (20.25 vs 45.0 mg; P  = 0.0059) and from 60 to 72 h postoperatively (15.0 vs 33.75 mg; P  = 0.0350). In patients who stayed longer than 72 h, the median cumulative analgesic consumption in those who received liposomal bupivacaine was statistically significantly lower than those who received bupivacaine/epinephrine (120.0 vs 296.5 mg; P  = 0.0414). Median length of stay for the liposomal bupivacaine and bupivacaine/epinephrine groups were 45:05 h and 44:29 h, respectively. There were no adverse events related to blocks performed with liposomal bupivacaine.



Thoracic surgery patients who have blocks performed with liposomal bupivacaine require fewer analgesics postoperatively. This may decrease complications related to poor pain control and decrease side effects related to narcotic use in our patient population.
Georgetown University School of Medicine, Washington, DC, USA.
Salvatore A
SA
Parascandola
Georgetown University School of Medicine, Washington, DC, USA.
Jessica
J
Ibañez
Georgetown University School of Medicine, Washington, DC, USA.
Graham
G
Keir
Georgetown University School of Medicine, Washington, DC, USA.
Jacqueline
J
Anderson
Department of Medicine, Georgetown University Hospital, Pasquerilla Healthcare Center, Washington, DC, USA.
Michael
M
Plankey
Department of Medicine, Georgetown University Hospital, Pasquerilla Healthcare Center, Washington, DC, USA.
Deanna
D
Flynn
Department of Anesthesia, Georgetown University Hospital, Washington, DC, USA.
Candice
C
Cody
Department of Anesthesia, Georgetown University Hospital, Washington, DC, USA.
Lorenzo
L
De Marchi
Division of Thoracic Surgery, Department of General Surgery, Georgetown University Hospital, Washington, DC, USA.
Marc
M
Margolis
Division of Thoracic Surgery, Department of General Surgery, Georgetown University Hospital, Washington, DC, USA.
M
M
Blair Marshall
D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000779:Anesthetics, Local; D008081:Liposomes; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine
Liposomal bupivacaine; Pain management; Video-assisted thoracoscopic surgery