Comparison of analgesic efficacy and safety between liposomal bupivacaine and ropivacaine for paravertebral block in patients undergoing thoracoscopic lung tumor surgery: a prospective double-blind randomized controlled trial.

Background: Thoracoscopic lung tumor surgery is associated with significant postoperative pain. While liposomal bupivacaine (LB) provides prolonged analgesia, its higher cost and extended duration profile have not been directly compared with ropivacaine, a commonly used long‑acting local anesthetic in paravertebral blockade. Whether these differences translate into meaningful clinical benefits remains uncertain. This study assessed the utility of LB as an alternative method for pain control through a comparison with ropivacaine. Methods: In this prospective, double-blind, randomized controlled trial, 200 patients scheduled for elective thoracoscopic lung tumor surgery were randomly assigned to control [paravertebral block (PVB) with 10 mL of 0.75% ropivacaine; n=100] or experimental (PVB with 10 mL of 1.3% LB; n=100) groups. Postoperative patient-controlled intravenous analgesia (PCIA) with hydromorphone (10 mg/180 mL; background: 0 mL/h; bolus: 5 mL; lockout: 15 min) was initiated in all patients. Primary outcomes included pain scores of the Numerical Rating Scale (NRS) at rest and during movement at 6, 12, 24, 36, 48, and 72 hours post-operation; and the cumulative morphine milligram equivalent (MME) at 0-<24, 24-<48, 48-72, and 0-72 hours (including both PCIA and rescue analgesics). Secondary outcomes included PCIA doses, rescue analgesia, and adverse events within 72 hours. Exploratory 3‑month telephone follow‑up assessed pain presence during usual activities and breathing. Results: Of 200 randomized patients, 184 completed in‑hospital follow‑up (92 per group) and were included in the primary analysis.Sixteen patients were excluded after randomization (3 due to cancelled surgery, 4 due to reoperation, 5 due to postoperative complications, and 4 due to withdrawal of consent). Compared with the control group, the LB group showed significantly lower resting NRS scores at 12, 24, 36, and 48 hours (P=0.04, 0.04, 0.02, and 0.01, respectively) and dynamic NRS scores at all time points (6, 12, 24, 36, 48, and 72 hours) (P=0.02, 0.001, 0.002, 0.04, 0.03, and 0.046, respectively). MME consumption was significantly reduced in the LB group during the 48- to 72-hour interval (P=0.03) and cumulatively over 0-72 hours (P=0.03). The number of delivered PCIA doses was significantly lower in the LB group during the 48- to 72-hour interval (P=0.02), with no significant differences in the 0 to 24- or 24- to 48-hour intervals. Rescue analgesia rates (3.3% Conclusions: In thoracoscopic lung tumor surgery, PVB with LB provides improved and sustained postoperative analgesia and reduces opioid consumption as compared with ropivacaine, without increasing the incidence of adverse events. It may represent a safe and effective single-injection alternative for multimodal analgesia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400093464.