Efficacy of different nerve block techniques with liposomal bupivacaine for postoperative analgesia in patients undergoing single-port video-assisted thoracoscopic partial lung resection.

Objective: To compare postoperative analgesia efficacy between liposomal bupivacaine-administered thoracic paravertebral blockade (TPVB) and thoracoscopic direct intercostal nerve blockade (INB) in uniportal video-assisted thoracoscopic surgery (VATS) for partial lung resection. Methods: A randomized controlled design enrolled 60 elective surgery patients, randomized in a 1:1 ratio to TPVB or INB groups. TPVB received 133 mg liposomal bupivacaine (20 mL) via ultrasound-guided T4 injection; INB got the same dose via thoracoscopic-guided 3rd-7th intercostal injection. Primary endpoint: 72-h postoperative VAS scores at rest/coughing. Secondary outcomes: sufentanil use, PCIA presses, rescue analgesics, complications, and 1-6 month chest pain NRS scores. Results: Baseline demographic and clinical characteristics were comparable between the two groups. No significant differences in VAS scores at 6 h, 24 h, 48 h, or 72 h (all Conclusion: For uniportal VATS, liposomal bupivacaine administered via TPVB or INB showed no statistically significant differences at the primary 6-h assessment or subsequent time points in early analgesia, safety, or long-term chronic pain impact. Pain scores were low in both groups throughout the 72-h period. However, the results do not establish equivalence between the two approaches, and as this trial compared two active interventions without a placebo arm, the absolute analgesic efficacy of each technique cannot be independently determined. Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=206795, ChiCTR2300075637.