Liposomal Bupivacaine versus Bupivacaine with Dexamethasone for Rhomboid Intercostal and Sub-Serratus Block in Thoracoscopic Lobectomy: A Randomized Controlled Trial.

Background: Liposomal bupivacaine may prolong analgesia in regional anesthesia; however, its effectiveness in fascial plane blocks remains uncertain. This study compared liposomal bupivacaine plus bupivacaine with bupivacaine plus dexamethasone for rhomboid intercostal and sub-serratus (RISS) plane block for postoperative analgesia following thoracoscopic lobectomy. Methods: In this randomized, double-blind, parallel-group trial, 78 patients undergoing thoracoscopic lobectomy were randomly assigned (1:1) to receive either liposomal bupivacaine plus bupivacaine (LB group, n = 39) or bupivacaine plus dexamethasone (BD group, n = 39) for RISS block. The primary outcome was the area under the curve (AUC) of resting Numeric Rating Scale (NRS) pain scores over 72 h postoperatively. Secondary outcomes included the AUC for cough NRS scores within 72 h postoperatively, NRS scores at 72 h postoperatively, duration of analgesia, cumulative oxycodone consumption postoperatively, and the incidence of adverse effects. Results: The AUC of resting NRS pain scores over 72 h postoperatively was comparable between the LB and BD groups (110.8 ± 15.6 vs 113.4 ± 19.9 score·h; MD = 2.551, 95% CI -14.57 ~ 19.68, Conclusion: Compared with bupivacaine plus dexamethasone, liposomal bupivacaine for RISS block in thoracoscopic lobectomy did not improve postoperative analgesia or reduce oxycodone consumption. Moreover, although liposomal bupivacaine prolonged the duration of analgesia, the clinical benefit was limited.