Is the Role of Liposomal Bupivacaine the Future of Analgesia for Thoracic Surgery? An Update and Review

A Provocative Dilemma: Liposomal Bupivacaine Versus Bupivacaine With Epinephrine for Intercostal Nerve Blocks With Enhanced Recovery During Robotic Thoracic Surgery

“…There is a two-fold release of the medication, first through systemic absorption of the highly protein-bound bupivacaine, and second through the liposomal core of bupivacaine, which slowly is released over 72 hours. 7 The onset of liposomal bupivacaine analgesic effect takes about four hours 8 ; therefore, this should account for the difference that was observed in this study with the patients in the PACU and opioid use, although there were not clinically statistical significant differences between the groups studied. The provocative dilemma to determine the optimal local anesthetic with ICNBs continues to be a challenge.…”

“…In contrast, in the study by Kodia et al, 6 the dermatomes blocked included nine intercostal spaces and perhaps had better dermatome coverage in terms of pain control, whereas liposomal bupivacaine showed superiority over bupivacaine with epinephrine because of the prolonged duration of block with liposomal bupivacaine. 7 The blockade of nine dermatomes, particularly when the potential for anesthetic toxicity exists, can be a point of discussion. Although the authors recognize that there is a lower risk of anesthetic toxicity with liposomal bupivacaine due to the pharmacokinetics of the medication, 7 Kodia et al 6 did follow the recommended dosage of liposomal bupivacaine 266 mg or bupivacaine with epinephrine 2.5 mg/kg in each patient.…”

Does the Analgesic Technique in the Intraoperative Period Have Any Influence on Chronic Pain after Uniportal Video-Assisted Thoracoscopic Surgery?

“…For instance, the use of liposomal bupivacaine for paravertebral blocks in VATS has shown an analgesic effect up to 72 hours. 7 In addition, there are pain adjuvants that can be administered during surgery such as ketamine, lidocaine, and magnesium that would lower pain scores postoperatively without having a direct effect on the actual hypothesis.…”

Choosing the Best Method for Postoperative Regional Analgesia After Video-Assisted Thoracoscopic Surgery

“…TEA and PVB have been considered the gold standard for early postoperative pain management after thoracic surgery. 10 However, the roles of TEA and PVB after VATS remain controversial, 11 and most studies combine VATS patients with thoracotomy patients, with relatively few studies focusing on VATS exclusively. In the absence of an accepted standard of care for analgesia in VATS, studies have compared a broad range of regional analgesia techniques, therefore introducing heterogeneity into the available body of evidence and making drawing definite conclusions difficult at best.…”