Liposomal bupivacaine versus ropivacaine thoracic paravertebral block for thoracoscopic atrial septal defect repair: analgesic efficacy and cardiac biomarker outcomes in a single-center, assessor-blinded, randomized trial.

Authors

Bingqian Li, Yuxin Gao, Jingjing Han, Yan Li, Yu Chen

Published in

Journal of thoracic disease. Volume 18. Issue 9. Pages 1049. Sep 30, 2026. Epub Sep 24, 2026.

Abstract

Thoracoscopic atrial septal defect (ASD) repair, although minimally invasive, can cause substantial postoperative pain. Thoracic paravertebral block (TPVB) provides effective chest wall analgesia, and liposomal bupivacaine (LB), a long-acting local anesthetic with sustained release, may prolong analgesic duration. We investigated whether ultrasound-guided TPVB using long-acting LB improves postoperative analgesia without compromising cardiovascular safety compared with ropivacaine (RP).
This randomized, assessor-blinded trial enrolled 94 patients undergoing thoracoscopic ASD repair, who were randomly assigned (1:1) to receive ultrasound-guided TPVB with either LB or RP. Eligibility criteria included age 18-55 years, American Society of Anesthesiologists (ASA) II-III, New York Heart Association (NYHA) II-III, and ejection fraction (EF) >50%. Randomization was computer-generated with sealed envelopes. Safety monitoring included continuous electrocardiography (ECG) for arrhythmias, with Clavien-Dindo grading and Naranjo causality assessment. The primary endpoint was the numerical rating scale (NRS, 0-10) pain score during coughing at 24 h postoperatively. Secondary outcomes included NRS scores at other time points, 72-h opioid consumption (morphine milligram equivalents, MME), time to first rescue analgesia, extended analgesia outcomes [postoperative days 4-7 (POD4-POD7)], perioperative hemodynamics, postoperative recovery, cardiac/inflammatory biomarker trajectories, and adverse events (with postoperative arrhythmias analyzed separately).
Baseline demographic, clinical, and intraoperative variables were well-balanced between groups (all P>0.05). Compared with RP, LB was associated with lower NRS pain scores at rest and during coughing from extubation through 72 h (all P<0.05), including the primary endpoint at 24 h. LB significantly reduced 72-h opioid consumption [median interquartile range (IQR) 7.5 (0, 42) mg vs. 45 (30, 67.5) mg; P<0.001] and increased the proportion of patients requiring no rescue analgesia within 72 h (72.4% vs. 27.6%; P=0.003). Time to first rescue analgesia was numerically longer with LB (20.5 h vs. 12.0 h; P=0.10), and opioid-sparing effects persisted on POD4-POD7 (both P<0.001). Mechanical ventilation duration was shorter in the LB group [5 (3, 6) h vs. 6 (4, 7.5) h; P=0.03]. Cardiac and inflammatory biomarker trajectories did not differ between groups. Non-arrhythmic adverse events were comparable, and postoperative arrhythmia incidence within 30 days was similar between groups (13.3% vs. 15.6%).
In adults undergoing thoracoscopic ASD repair, LB-based TPVB provides superior early analgesia with sustained opioid sparing and shorter mechanical ventilation duration, without signals of increased cardiovascular risk, including postoperative arrhythmias. These findings support considering LB-TPVB as part of multimodal analgesia for thoracoscopic ASD repair, pending confirmation in larger multicenter studies.
ChiCTR2500112278, retrospectively registered at the Chinese Clinical Trial Registry on November 12, 2025.

PMID:
42865813
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.