Liposomal Bupivacaine Enhances the Pain-Control Benefits of Uniportal Thoracoscopic Lobectomy

Liposomal bupivacaine field block is gaining popularity as a critical element of enhanced recovery after surgery protocols in thoracic surgery. Uniportal thoracoscopic surgery has been reported to result in less narcotic consumption compared with traditional video-assisted thoracoscopic surgery. The objective of this study was to evaluate the postoperative narcotic consumption of patients undergoing uniportal thoracoscopic lobectomy with the use of 0.25% bupivacaine vs patients treated with liposomal bupivacaine.All consecutive patients undergoing uniportal thoracoscopic lobectomy at an academic medical institution were recorded between October 2015 and February 2018. Narcotic consumption was converted to oral morphine equivalents by using standard formulas. Patients underwent posterior serratus and intercostal nerve blocks with 0.25% bupivacaine or liposomal bupivacaine, transitioning to liposomal bupivacaine in March 2017. Other adjuncts such as gabapentin or cyclooxygenase-2 inhibitors were not administered.Data were reviewed on 32 patients receiving field blocks with 0.25% bupivacaine and on 50 patients receiving liposomal bupivacaine. There was no difference between groups with regard to age, sex, chest tube duration, or length of stay. Patients undergoing field blocks with liposomal bupivacaine consumed less narcotic medication.The study investigators have previously demonstrated decreased narcotic consumption with the use of uniportal technique over traditional multi-incision thoracoscopic surgery. The use of liposomal bupivacaine for posterior serratus and intercostal field blocks enhanced pain control and decreased narcotic consumption.