Liposomal bupivacaine intercostal block placed under direct vision reduces morphine use in thoracic surgery.

Autor:	Singh A; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., McAllister M; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., De León LE; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Kücükak S; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Rochefort MM; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Mazzola E; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA., Maldonado L; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Hartigan PM; Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA., Jaklitsch MT; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Swanson SJ; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Bueno R; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Deeb AL; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Patil N; Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Feb 29; Vol. 16 (2), pp. 1161-1170. Date of Electronic Publication: 2024 Feb 23.
DOI:	10.21037/jtd-23-1405
Abstrakt:	Background: Thoracic epidural analgesia (TEA) and liposomal bupivacaine (LB) are two methods used for postoperative pain control after thoracic surgery. Some studies have compared LB to standard bupivacaine. However, data comparing the outcomes of LB to TEA after minimally invasive lung resection is limited. Therefore, the objective of our study was to compare postoperative pain, opioid usage, and outcomes between patients who received TEA vs . LB. Methods: We conducted a retrospective chart review of patients who underwent minimally invasive lung resections over an 8-month period. Intraoperatively, patients received either LB under direct vision or a TEA. Pain scores were obtained in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. Morphine milligram equivalents (MMEs) were calculated at 24 and 48 hours postoperatively. Postoperative outcomes were then compared between groups. Results: In total, 391 patients underwent minimally invasive lung resection: 236 (60%) wedge resections, 51 (13%) segmentectomies, and 104 (27%) lobectomies. Of these, 326 (83%) received LB intraoperatively. Fewer patients in the LB group experienced postoperative complications (18% vs . 34%, P=0.004). LB patients also had lower median pain scores at 24 (P=0.03) and 48 hours (P=0.001) postoperatively. There was no difference in MMEs at 24 hours (P=0.49). However, at 48 hours, patients who received LB required less narcotics (P=0.02). Median hospital length of stay (LOS) was significantly shorter in patients who received LB (2 vs . 4 days, P<0.001). On multivariable analysis, increasing age, postoperative complications, and use of TEA were independently associated with a longer hospital LOS. Conclusions: Compared to TEA, LB intercostal block placed under direct vision reduced morphine use 48 hours after thoracic surgery. It was also associated with fewer postoperative complications and shorter median hospital LOS. LB is a good alternative to TEA for pain management after minimally invasive lung resection. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1405/coif). A.S. is personally funded by the John D. Mitchell Fellowship. R.B. has research grants and clinical trials support from MedGenome, Roche, Verastem, Genentech, Merck, Bicycles therapeutics, Serum, Intuitive, Siemens, NIH and DOD. Additionally, he has four patents through BWH (no royalties to date) and equity in a new start-up company, Navigation Sciences. These disclosures or conflicts of interest are not relevant to this manuscript. The other authors have no conflicts of interest to declare. (2024 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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