Intercostal Nerve Blocks With Liposomal Bupivacaine: Demonstration of Safety, and Potential Benefits

Liposomal bupivacaine is designed to allow drug diffusion for up to 96 hours following a single administration. Our study aimed to evaluate the safety of liposomal bupivacaine as an intercostal nerve block as part of an enhanced recovery pathway using standardized multimodality pain regimen compared with epidural analgesia in propensity score-matched patients undergoing lung resection. Patients undergoing lung resection (n = 1737; 2010-2015) were stratified by treatment with intraoperative liposomal bupivacaine intercostal block vs epidural analgesia. We performed 2 propensity score matching analyses. In the first, propensity for treatment with liposomal bupivacaine was estimated using pretreatment variables and the patients were matched on the propensity score. The variables were age, neoadjuvant therapy, extent of resection, and the Zubrod score. In the second, the propensity score matching was performed only in patients who had a thoracotomy. Perioperative outcomes were compared between groups using paired statistical analysis techniques. In the first analysis (n = 1236), there were more thoracotomies performed in the epidural group (P < 0.0001). The rate of pulmonary, gastrointestinal, wound, and neurologic complications was similar between the groups, but there were more cardiovascular complications in the epidural arm (P = 0.02), mostly atrial arrhythmias. In the second analysis (n = 494), there were no differences in the rate of postoperative complications between the groups. The use of liposomal bupivacaine is not associated with a rise in perioperative complications when compared with epidural analgesia. Liposomal bupivacaine is a safe adjunct to the management of pain of patients undergoing pulmonary surgery.