Application of thoracic paravertebral nerve block with liposomal bupivacaine for postoperative analgesia after breast surgery

PENG Yue; DENG Jiali; DENG Mengjuan; YANG Shangze; ZHAN Xiaoxuan; DENG Huan; WU Yifei

doi:10.3969/j.issn.2096-2681.2025.05.004

Abstract：Objective To evaluate the efficacy of a single-shot thoracic paravertebral nerve block(TPVB)with liposomal bupivacaine for postoperative analgesia after breast surgery.Methods Eighty female patients,aged 18-64 years,with body mass index(BMI)17-29 kg/m2,of American Society of Anesthesiologists(ASA)physical status Ⅰ-Ⅲ,underwent elective unilateral breast cancer resection at the Eighth Affilliated Hospital of Sun Yat-sen University from June 2023 to December 2024 were selected.Patients were divided into two groups,the ropivacaine group(group R,n=40)and the liposomal bupivacaine group(group LB,n=40),according to random number table method.All patients received ultrasound-guided T4-T5 TPVB on the affected side.Group LB received liposomal bupivacaine 133 mg,while group R received 0.5%ropivacaine 100 mg,both diluted with normal saline to 20 mL.The patients'age,BMI,operation time,anesthesia time,onset time of TPVB and recovery time were recorded.Heart rate(HR),pulse oxygen saturation(SpO2),the mean arterial pressure(MAP)before TPVB,after TPVB,at skin incision and after laryngeal mask removal were recorded.The numerical rating scale(NRS)scores at rest and during activity at 1,4,8,12,24,48 and 72 h after the operation were recorded.The postoperative hospital stay,the number of patients who received additional parecoxib sodium at 0-24 h,24-48 h,and 48-72 h after the operation,as well as the occurrence of adverse reactions such as nausea,vomiting,constipation,respiratory depression,and toxic reactions of local anesthetics were also recorded.Results There was no statistical significance in the comparisons of the general conditions,vital signs before TPVB,after TPVB,during skin incision,and after laryngeal mask removal between the two groups(P＞0.05).Compared with group R,the NRS scores at rest and during activity at 4,12,24,48,and 72 h after surgery in group LB were significantly lower(P＜0.05),meanwhile the usage rate of intravenous analgesia with parecoxib sodium at 0-24 h and 24-48 h after the operation was significantly decreased(P＜0.05).The incidence of postoperative fever,constipation,nausea,respiratory depression,and local anesthetic toxicity didn't increase.Conclusion A single-shot TPVB with liposomal bupivacaine for postoperative analgesia after breast surgery can provide long-acting analgesic effects,reduce the need for remedial analgesia and postoperative adverse reactions,and facilitate postoperative recovery of patients.