Liposomal Bupivacaine versus Ropivacaine for Rhomboid Intercostal and Subserratus Plane Blocks in Video-Assisted Thoracoscopic Surgery: A Randomised Controlled Trial.

In 30 seconds

This single-centre randomised controlled trial compared liposomal bupivacaine (LB) with ropivacaine (RP) for ultrasound-guided rhomboid intercostal and subserratus plane blocks in patients undergoing video-assisted thoracoscopic surgery. Among 93 analysed patients, LB was associated with lower resting pain-score area under the curve over 48 hours than RP (66.5 [55.0 to 84.8] vs 112.0 [104.0 to 123.4]; P < 0.001). LB also reduced rescue analgesia and improved 48-hour recovery scores, although its initial resting analgesic effect was less potent. Perioperative complications were similar between groups.

Key findings

• Resting NRS-AUC over 48 hours was 66.5 [55.0 to 84.8] with LB versus 112.0 [104.0 to 123.4] with RP (P < 0.001).
• Dynamic NRS-AUC over 48 hours was 137.0 [116.2 to 149.0] with LB versus 191.0 [183.1 to 208.5] with RP (P < 0.001).
• Rescue analgesia occurred in 23.40% with LB versus 54.35% with RP (P = 0.004); 48-hour QoR-40 scores were 172.00 [169.50 to 175.00] versus 162.50 [159.25 to 164.75] (P < 0.001).
• At 12 hours, resting NRS-AUC was higher with LB than RP (22.0 [19.0 to 26.2] vs 16.5 [14.0 to 22.0]; P < 0.001); dynamic scores were comparable (P = 0.846).

Why it matters

The findings suggest that the choice of local anaesthetic for RISS blocks may affect pain control across the postoperative period, rescue analgesia use, and early recovery after VATS. The less favourable initial resting pain result with LB alongside better 48-hour outcomes highlights the importance of considering analgesia over time rather than relying on an early assessment alone.

What to keep in mind

The trial was single-centre, analysed 93 patients, and had 72-hour follow-up; the authors call for larger multicentre trials.