A rapid UPLC-MS/MS method for therapeutic drug monitoring of bupivacaine: Validation and clinical application in perioperative analgesia.

Niacin accelerates skeletal muscle regeneration and enhances C2C12 differentiation by activating the PI3K/Akt signaling pathway.

BackgroundPostoperative pain management after cardiac surgery involves a multimodal approach. Recently, the erector spinae plane (ESP) block has been incorporated into multimodal pain control protocols. These measures have been taken to increase patient satisfaction while minimizing opioid usage. Prospective data is lacking to guide decisions regarding optimal regional anesthetic agents. This randomized controlled pragmatic trial protocol seeks to determine the benefit of liposomal bupivacaine relative to plain bupivacaine hydrochloride at reducing postoperative opioid consumption and other clinical outcomes following cardiac surgery.MethodsThe investigators anticipate consenting 150 subjects to obtain 96 evaluable subjects undergoing minithoracotomy (N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride) or open sternotomy (N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride). The primary outcome will be postoperative opioid consumption, reported in morphine equivalents. Secondary outcomes will include postoperative nonopioid analgesic consumption, inpatient and outpatient postoperative pain scores, 30-day mortality and major morbidity rates, postoperative quality of life, and hospitalization costs. Double blinding will be conducted with necessary measures taken to mask electronic medical records and drug preparation.DiscussionThe trial is currently enrolling subjects at a single academic medical center in the northeastern United States. The current study aims to investigate the postoperative pain reported by patients undergoing cardiac surgery when receiving ESP blocks with liposomal bupivacaine (experimental) compared to its hydrochloride formulation (control).Trial registrationClinicalTrials.gov NCT06077422. Registered on October 2023. https://clinicaltrials.gov/study/NCT06077422?tab=table.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-026-09620-8.

This study investigated the impact of transversus abdominis plane (TAP) blocks containing bupivacaine hydrochloride, dexamethasone, and dexmedetomidine on postoperative outcomes following laparoscopic colorectal resections. This retrospective cohort study included patients who had undergone elective laparoscopic colorectal resections between 2019 and 2022. Patients received either local wound infiltration or TAP blocks. TAP blocks were comprised of bupivacaine hydrochloride, dexamethasone, and dexmedetomidine. Local infiltration was with bupivacaine alone. Postoperative morphine milligram equivalents (MME) and visual analog scale (VAS)scores were compared. Predictors of MME and length of stay (LOS) were investigated by multiple linear regression. A total of 195 patients met the inclusion criteria. Among them, 90 (46.1%) received local wound infiltration, while 105 (53.9%) received TAP blocks. Patients in the TAP block group experienced lower postoperative MME at 24 hours (49.9 mg vs. 77.33 mg, p = 0.028) and a shorter LOS of 4.4 ± 2.2 days compared to 6.1 ± 5.1 days (p = 0.001). VAS scores showed statistically similar results between treatment groups at all three postoperative time points. Additionally, TAP blocks were associated with a reduced incidence of postoperative ileus (0% vs. 5%, p = 0.01). Multiple linear regression indicated that TAP blocks were independently associated with lower MME at 24 hours after surgery (β = -31.3, 95% CI: -57.5 to -5.1, p = 0.019) and a shorter LOS (β = -1.9, 95% CI: -3.4 to -0.4, p = 0.013). TAP blocks using bupivacaine, dexamethasone, and dexmedetomidine are associated with decreased opioid consumption at 24 hours, shorter LOS, and reduced ileus compared to local infiltration alone.

The limited duration of action of bupivacaine hydrochloride in thoracic paravertebral nerve block (TPVB) contributes to high rates of acute and chronic postsurgical pain (CPSP) following video-assisted thoracoscopic surgery (VATS). The efficacy of long-acting liposomal bupivacaine (LB) in VATS remains inconclusive. This randomized, double-blind trial involved 146 patients undergoing elective VATS, who received TPVB with either 20 ml of 0.887% liposomal bupivacaine (LB group) or 20 ml of 0.25% bupivacaine hydrochloride (B group). This study was registered with the Chinese Clinical Trial Registry on July 31, 2024. The primary outcome was the area under the curve (AUC) of numerical rating scale (NRS) pain scores over the first 72 h postoperatively. Secondary outcomes included NRS scores at 72 h and at 1, 3, and 6 months postoperatively; concentrations of inflammatory markers within 48 h postoperatively; analgesic consumption; patient-controlled intravenous analgesia (PCIA) presses; postoperative hospitalization duration; and the incidence of postoperative adverse reactions and complications. The AUC of NRS scores at rest and during movement was significantly lower in the LB group compared to the B group during the first 72 h postoperatively (P < 0.05). At 1 and 3 months postoperatively, the LB group showed significantly lower NRS scores and a 58% reduction in CPSP incidence (28.6% vs. 48.6%; P < 0.001). The LB group required fewer effective and total PCIA presses, as well as reduced supplemental analgesic doses during the first 48 postoperative hours (P < 0.01). Fewer complications, including subcutaneous emphysema and pneumonia, were observed in the LB group (P < 0.01). Additionally, inflammatory responses were attenuated, as indicated by decreased interleukin-1β levels within 48 h and lower C-reactive protein levels at 24 h (P < 0.05). No significant differences were observed between the groups in other secondary outcomes. Liposomal bupivacaine for TPVB significantly alleviated both acute and chronic postsurgical pain, reduced analgesic requirements, and did not increase pulmonary complications.

A disadvantage of regional blocks is their limited period of efficacy. One of the medications that has been found to have the ability to extend the duration of effect is dexamethasone. For the purpose of determining the duration of analgesia after administration of 4 mg of dexamethasone via the intravenous and perineural routes following an ultrasound (USG)-guided supraclavicular brachial plexus block. To compare the duration of analgesia between perineurial and intravenous dexamethasone when giving supraclavicular USG-guided brachial plexus block, time of administering rescue analgesia, and any adverse events like postoperative nausea and vomiting (PONV). This comparative observational study involved 100 adults, aged 18-70 years, with ASA physical status between I and III, who were scheduled to undergo elective procedures of the upper limb under USG-guided supraclavicular brachial plexus block, and were assigned to either the perineural group or intravenous group. Patients in the perineural group (n = 50) were given 10 mL of 0.5% bupivacaine hydrochloride, 10 mL of 2% lidocaine hydrochloride with adrenaline 1:200,000 (5 μg/mL), and 4 mg of dexamethasone. Patients in the intravenous group (n = 50) were given an additional 4 mg of dexamethasone intravenously just before giving the local anesthetic mixture into the brachial plexus. The extent of analgesia, pain, adverse effects like PONV, and rescue analgesia required were recorded. Up to 24 h after the procedure, a greater segment of patients in the perineural group reported analgesia (72% vs. 24%; P = 0.001) and a reduction in pain (76% vs. 36%; P = 0.001). Adverse effects like PONV were minimal and comparable. Patients in the intravenous group received rescue analgesia with paracetamol 1 g intravenous repeated every 6 h when VAS score is 3 or more. Patients with VAS score of 1 or 2 did not receive any rescue analgesics. Second rescue analgesic is injection diclofenac 75 mg intramuscular repeated every 6 h if paracetamol fails. When compared to the intravenous route, the perineural route of dexamethasone was shown to be beneficial in extending the duration of anesthesia for up to 24 h, which resulted in prolonged pain-free and a reduced need for rescue analgesia. Furthermore, enhanced recovery was noted in patients when dexamethasone was given via the perineural route due to the extended duration of pain relief.

We read with considerable interest the randomized clinical trial by Ye et al[1] investigating the efficacy of liposomal bupivacaine (intervention) versus bupivacaine hydrochloride (control) in the superficial parasternal intercostal plane (SPIP) block in cardiac surgery patients. The study’s primary outcome, cumulative opioid consumption over the first 3 postoperative days, addressed a critical clinical question, as optimizing postoperative analgesia while minimizing opioid use remains a key goal in cardiac surgical care. The trial’s findings are noteworthy yet surprising[1]: while liposomal bupivacaine significantly reduced the incidence of moderate-to-severe cough-related pain within 48 h post-extubation in patients undergoing median sternotomy, it failed to reduce 3-day cumulative opioid intake compared with bupivacaine hydrochloride. This discrepancy between pain relief and opioid consumption merits in-depth analysis, as it challenges conventional expectations of regional analgesia’s role in opioid sparing and highlights important nuances in study design and pharmacologic behavior. As the authors acknowledged, one potential explanation for this finding is the standardized use of continuous low-dose oxycodone via patient-controlled intravenous analgesia (PCIA). Such background systemic analgesia is a double-edged sword: while it ensures baseline pain control, it can also mask subtle differences in opioid requirements that might otherwise emerge between regional analgesia groups. To explore this further, a post-hoc sensitivity analysis was conducted, excluding the baseline PCIA infusion volume from the opioid consumption calculations. Notably, this analysis revealed a significant reduction in opioid use in the liposomal bupivacaine group on postoperative day 2, although no differences were observed on days 1 or 3. This time-dependent effect, which was not emphasized in the original study, aligns with the pharmacokinetic profile of liposomal bupivacaine and offers a critical context for interpreting the primary outcome. Pharmacokinetic studies have consistently demonstrated that liposomal bupivacaine exhibits variable release kinetics in fascial and intercostal nerve blocks, characterized by an initial low-level release followed by a delayed second peak at 24–48 h post-injection[2]. While this prolonged release profile extends the analgesic duration compared with plain bupivacaine, the low concentration of drug released beyond 48 h is often insufficient to maintain therapeutic analgesic levels for a full 72 h. This pharmacologic property directly explains the trial’s observations: the significant reduction in pain scores at 48 h post-extubation correlates with the drug’s delayed peak effect, and the sensitivity analysis’s day-2 opioid reduction reflects this period of optimal analgesia. In contrast, bupivacaine hydrochloride exerts its peak effect within 12–24 h, accounting for equivalent opioid consumption on postoperative day 1 (when both agents are maximally effective) and waning efficacy by day 3 (when neither agent maintains sufficient analgesia, leading to similar opioid requirements). Another important consideration omitted from the original study is the risk of rebound pain following peripheral nerve block cessation – a phenomenon recently linked to increased 30-day postoperative opioid prescriptions by Chung and colleagues[3]. Rebound pain occurs when the abrupt resolution of regional analgesia exposes patients to unrelieved acute pain, prompting increased opioid use. Liposomal bupivacaine’s extended analgesic duration (>48–72 h) theoretically mitigates this risk, as its gradual drug release avoids the sudden analgesic gap observed with plain bupivacaine. However, without a no-block control group, this trial could not assess this potential advantage. Including a third arm without SPIP block would have allowed for a direct comparison of opioid consumption across liposomal bupivacaine, bupivacaine hydrochloride, and no regional analgesia – providing critical data on both relative efficacy and rebound pain prevention. Despite these limitations, the study by Ye et al makes a valuable contribution to the literature. The demonstration that liposomal bupivacaine reduces moderate-to-severe cough-related pain in patients undergoing cardiac surgery is clinically meaningful, as cough pain is a major source of morbidity and can impair respiratory function and wound healing. Additionally, the sensitivity analysis reinforced that liposomal bupivacaine does offer opioid-sparing effects during its peak analgesic period (postoperative day 2), even if masked by systemic background analgesia in the primary analysis. In conclusion, this trial underscores the importance of aligning outcome measurements with the pharmacokinetic profile of regional analgesics and considering the impact of concurrent systemic analgesia on study results. Future trials evaluating liposomal bupivacaine in cardiac surgery should incorporate time-point-specific opioid consumption analyses, including no-block control groups to assess rebound pain, and optimize PCIA protocols to minimize masking of regional analgesia effects. Such design refinements will enhance our understanding of the role of liposomal bupivacaine in postoperative pain management and facilitate more informed clinical decision-making.

Abstract Context: Hyperbaric bupivacaine (BN) (0.5%) was the gold standard drug of choice for intrathecal use in spinal anaesthesia. Numerous studies have examined the usefulness and efficacy of ropivacaine (RN) and levobupivacaine (LN) when used as an isobaric local solution, which offers a significant margin of safety. Hyperbaric RN (0.75%) and LN (0.5%) introduced recently in the anaesthesia practice provide a better and wider margin of safety in terms of decreasing the local anaesthetic systemic toxicity. We assessed and compared the effectiveness and efficiency of hyperbaric solutions, specifically 0.5% LN, 0.5% BN and 0.75% RN, in terms of motor and sensory blockade, haemodynamic stability and complications; the rationale for conducting this prospective study was to provide a higher margin of safety intrathecally. Aims: The primary objective of this study was to compare the duration of motor blockade of hyperbaric LN, BN and RN with nalbuphine adjuvant. Materials and Methods: Our study was a prospective double-blind block randomisation trial carried out in three groups, LN, BN and RN, with 40 patients in each group using nalbuphine as an adjuvant. Statistical Analysis Used: The onset, duration and regression of both motor and sensory parameters of the three hyperbaric local anaesthetic solutions were noted and analysed using the Chi-square test and analysis of variance. Results: On comparison, the onset of motor blockade was fastest in Group BN and slowest in Group LN ( P = 0.245). The motor regression time was significant in Group BN ( P = 0.020). On analysing the sensory parameters, the onset was comparable with Group BN and the fastest regression was noted in Group RN ( P = 0.049). The effective total analgesic duration and the time for first rescue analgesia showed statistical insignificance ( P = 0.158). Conclusion: The onset, duration and prolonged motor blockade characteristics were more pronounced in hyperbaric BN compared to LN and RN. The onset of sensory blockade is delayed in hyperbaric LN, and the sensory regression time was significantly faster in RN compared to BN and LN.

Tonsillectomy is one of the most commonly performed surgeries in Otolaryngology practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities especially pain continue to be a significant clinical concern. This prospective, double blind, Randomized Controlled Trial (RCT) was conducted at Department of ENT and Head-Neck surgery, Dhaka Medical College Hospital, Bangladesh from January 2021 to June 2022. Total 100 patients were enrolled through non-probability purposive sampling and according to the selection criteria, who were admitted for elective tonsillectomy. They were randomly allocated into two groups of 50 persons each- 'Intra-operative local infiltration of Bupivacaine' (B) and 'Normal saline' (N) group according to intervention applied on them. A significantly lower score on Wong-Baker Faces Pain rating scale (WBS) was found in group 'B' comparing with group 'N' at 4, 6 and 8 hours interval after the surgery. Group 'B' patients started their oral intake significantly sooner than group 'N' patients. On analysis Pre-incisional peritonsillar infiltration of 0.5% Bupivacaine hydrochloride is a safe and effective method to reduce early post-tonsillectomy pain. This intervention is also effective for earlier start of oral feeding and to decrease in the incidence of post-operative morbidities.

Liquid crystalline structure affects drug release from Pluronic® gels.

Operating Room Black Box Technology to Mitigate Local Anesthetic Systemic Toxicity Risk Associated With Liposomal Bupivacaine Administration.

This study compared liposomal bupivacaine (LB) and conventional bupivacaine hydrochloride (BH) for postoperative pain management among 50 female patients undergoing uniportal thoracoscopic lung surgery. The patients were randomized to LB (n = 25) or BH (n = 25) groups based on the intercostal nerve blocks they received post-surgery. Outcomes included intraoperative vital signs, pain scores (static/dynamic visual analog scale [VAS]), and adverse reactions (nausea, vomiting, and dizziness) assessed at 6, 24, 48, and 72h. Intraoperative vital signs (heart rate [HR], blood pressure, oxygen saturation, and bispectral index) and anesthetic/vasoactive drug administration exhibited no significant differences between groups. Postoperatively, the LB group demonstrated superior short-term analgesia, with significantly lower static and dynamic VAS scores at 6 and 24h in the LB group compared to the BH group [3(3,4) versus 4(4,4); 4(4,4) versus 5(4,6)] (p < 0.05). Between 48 and 72h, pain scores equalized between groups. Additionally, LB reduced nausea incidence after 24h (p < 0.05), with no severe adverse reactions reported in either group. Trend analysis revealed peak pain and adverse reactions at 24h, which subsequently declined in both groups. Although both anesthetics exhibited similar safety profiles, LB offered enhanced early pain relief and fewer nausea-related adverse effects. These findings suggest that LB improves short-term postoperative pain management without compromising safety. Further studies should explore its cost-effectiveness and long-term outcomes.

The effectiveness of liposomal bupivacaine for postoperative analgesia in thoracoscopic surgery remains uncertain. We assessed liposomal bupivacaine for erector spinae plane block (ESPB) on pain control after video-assisted thoracoscopic lung resection. In this multicenter, randomized controlled trial, 272 adults were randomly assigned (1:1) to receive either liposomal bupivacaine or bupivacaine hydrochloride for preoperative ultrasound-guided ESPB. The primary outcome was the cumulative numeric rating scale pain score at rest (area under the curve during 0-72h postoperatively). Secondary outcomes included 72-h cumulative activity pain, time to first patient-controlled analgesia, total opioid consumption within 72h, pain scores at multiple postoperative time points, recovery quality at 72h, and activity pain at 14days and 3months. A total of 267 patients were analyzed (median age, 58years; women, 64.8%). The 72-h cumulative rest pain was significantly lower in the liposomal bupivacaine group (205.0 vs 232.5; difference, -26.5; 95% confidence interval, -35.5 to -17.5; P < 0.001) but did not reach the minimal clinically important difference of 72 (predefined) or 42 (anchor-based). Pain scores at 24 and 32h, both at rest and during activity, achieved the clinically important difference of 1. Liposomal bupivacaine was associated with lower opioid consumption and higher recovery quality. The other outcomes did not differ between groups. Among patients undergoing video-assisted thoracoscopic lung resection, liposomal bupivacaine for ESPB led to a statistically significant reduction in 72-h cumulative rest pain compared with bupivacaine hydrochloride. Pain relief at 24 and 32h met the predefined threshold for clinical significance.

Effective pain management remains challenging in cardiac surgery. There is a lack of robust evidence on the use of superficial parasternal intercostal plane (SPIP) blocks with liposomal bupivacaine in median sternotomy. We therefore tested the primary hypothesis that bupivacaine liposomes can reduce cumulative opioid consumption in the initial three postoperative days. This single-center, randomized, blinded, active comparator-controlled trial included patients aged 18-65years undergoing elective cardiac valve surgery with midline sternotomy. Participants were randomized 1:1 to receive an SPIP block with either liposomal bupivacaine (intervention) or bupivacaine hydrochloride (control). The primary outcome was the cumulative opioid consumption over the first three postoperative days, analyzed using a log-linear regression model. Secondary outcomes included daily opioid use and pain scores at rest and during coughing, analyzed with repeated-measures mixed-effects linear regression. A total of 129 patients were analyzed (65 in the intervention group and 64 in the control group). Liposomal bupivacaine did not reduce the cumulative opioid consumption over the first three postoperative days compared to the control (estimated geometric mean ratio 0.95, 95% CI: 0.90-1.01, P =0.125). Daily opioid use also did not differ significantly (estimated geometric mean ratio 0.89, 95% CI: 0.78-1.01; P =0.077). However, patients in the liposomal bupivacaine had lower pain scores at resting (1.54±1.3 vs. 2.21±1.2, ratio of means 0.7, 95% CI: 0.58-0.84, P <0.001) and during coughing (3.07±1.29 vs. 3.72±1.19, ratio of means 0.83, 95% CI: 0.75, 0.91, P <0.001). Fewer patients in the intervention group experienced moderate-to-severe pain during coughing (53.85% vs. 78.13%, OR 0.33, 95% CI: 0.15-0.71, P =0.022) at 48hours after extubation. Liposomal bupivacaine for SPIP reduced the incidence of moderate to severe coughing pain at 48hours after extubation in patients undergoing cardiac surgery with sternotomy, suggesting potential benefits for postoperative analgesia.

Introduction: Bupivacaine (BPV) is a lipophilic local anesthetic (LA) that blocks voltage-gated sodium channels (Na v ) to prevent pain and provide analgesia during nerve blocks and epidural anesthesia. Though generally safe, BPV has the narrowest therapeutic window of all LAs and has been associated with fatal adverse events due to cardiotoxicity. Previous investigators have shown these events are due to BPV’s slow off-rate relative to other LAs, though the reasons for its slow off-rate are unknown, as is BPV’s binding site in cardiac Na v (Na v 1.5). Here we have investigated the structural basis of BPV’s cardiotoxicity by using cryogenic electron microscopy (cryo-EM) and electrophysiology to determine BPV’s binding site in Na v 1.5. These data allow comparison with other local anesthetics and provide the first step toward eliminating BPV’s cardiotoxicity. Hypothesis: BPV’s cardiotoxicity relative to other LAs is a result of unique binding pose in Na v 1.5. Approach: Cryo-EM data were collected from vitrified protein samples, then analyzed using CryoSparc. 3D reconstructions were fit with a model of Na v 1.5 in complex with BPV, then refined and validated using Phenix and Coot. Electrophysiology data were recorded by transfecting TsA201 cells with Na v 1.5-eGFP and measuring drug effect using voltage-clamp. Tonic block was measured by a long pulse to open the channel at 0.2Hz, whereas use-dependent block was recorded using a short pulse protocol at 10Hz. Statistics were performed using GraphPad Prism 8.0.2. Results: BPV binds to Na v 1.5 by p-stacking with the residue F1760 and making hydrophobic contacts with its unique alkyl chain. Recordings of wild-type Na v 1.5 and Na v 1.5-F1760A under voltage-clamp confirm the role of F1760 in in block of Na v 1.5 by BPV as the F1760A mutation reduces tonic block by 81.63% (54.66% 2.42% in WT vs 10.04% 9.30% in F1760A) and use-dependent block by 95.84% (79.29% 5.70% in WT vs 3.30% 7.64% in F1760A) in the presence of 100 µM BPV. Comparison of BPV’s pose to that of other drugs highlights the role of its unique alkyl chain in stabilizing binding and delaying recovery, which are key factors in the development of cardiotoxicity. Conclusions: BPV’s slow off-rate from Na v 1.5 derives from its unique alkyl chain, which is not necessary for lipophilicity or drug action. These data highlight the potential for modified, lipophilic LAs which retain high potency in nerve without causing cardiotoxicity.

Liposomal Bupivacaine Versus Ropivacaine With Perineural Dexamethasone in Adductor Canal Block for Total Knee Arthroplasty: A Randomized Clinical Trial.

BackgroundQP002 Long-acting local anaesthetic with bupivacaine and low-dose meloxicam as active ingredients for postoperative regional analgesia. The objective of the present study was to evaluate the safety, tolerability, and pharmacokinetics (PK) and pharmacodynamics (PD) of QP002 for postoperative analgesia following tension-free repair of an open unilateral inguinal hernia.MethodsThis was a multicentre, randomised, double-blind, positive-controlled trial. Patients were randomly assigned to receive a single injection of QP002 (five dose groups) with 0.25% bupivacaine hydrochloride 75 mg after open unilateral tension-free repair of an inguinal hernia. Pharmacokinetic parameters were evaluated by obtaining pharmacokinetic characteristic blood samples before and 120 hours after administration, at a total of 20 sampling points. Adverse events occurring after treatment were recorded from baseline to postoperative day 27 follow-up.ResultsA total of 40 patients with unilateral inguinal hernia were included in this study. In comparison to 0.25% bupivacaine hydrochloride 75 mg, the results demonstrate that QP002 was well tolerated, with no additional adverse events (AEs) observed and no instances of serious adverse events (SAEs). QP002 demonstrated prolonged absorption and clearance of bupivacaine, including a longer time to reach peak plasma concentration and a terminal elimination half-life. The peak plasma concentrations of 240 mg/7.2 mg QP002 (Cmax 250.33 ng/mL) were similar to those of 0.25% bupivacaine hydrochloride 75 mg (Cmax 258.40 ng/mL). Cumulative pain intensity scores at 24 hours postoperatively in the exercise state (NRS-A-AUC0-24) were lower in the QP002 dose groups than in the 0.25% bupivacaine hydrochloride 75 mg, with P = 0.0165 in the 320 mg/9.6 mg QP002 and P = 0.0435 in the 400 mg/12 mg QP002.ConclusionQP002 demonstrated favorable safety profiles and exhibited distinct extended-release pharmacokinetic (PK) characteristics in single-ascending-dose administration. High doses of QP002 showed potential for postoperative incisional infiltration to control pain. Future studies will further explore its efficacy and safety in broader clinical applications.

The efficacy, safety, pharmacokinetics, and pharmacodynamics of liposomal bupivacaine combined with bupivacaine hydrochloride administered via adductor canal block for total knee arthroplasty were evaluated. This randomized, double-blind, active-controlled, multicenter trial (NCT05139030) enrolled adults undergoing primary unilateral total knee arthroplasty. Participants were randomized 1:1 to receive an adductor canal block administered as a single dose of liposomal bupivacaine 133 mg admixed with bupivacaine hydrochloride 50 mg (liposomal bupivacaine group) or bupivacaine hydrochloride 50 mg admixed with saline (bupivacaine group). The study enrolled 167 participants (liposomal bupivacaine group, n = 85; bupivacaine group, n = 82). The primary endpoint was the area under the curve of numerical rating scale pain intensity scores from 0 to 96 hours postsurgery. From zero to 96 hours after surgery, the least squares mean (LSM) (SE) of the area under the curve of the numerical rating scale pain intensity score was lower in the liposomal bupivacaine group (568.9 [20.07]) versus the bupivacaine group (634.7 [20.04]) (LSM difference versus bupivacaine, ‒65.8 [95% CI (confidence interval), ‒118.7 to ‒12.9]; P = 0.0074). In the liposomal bupivacaine group, total opioid consumption was lower from 0 to 96 hours versus the bupivacaine group (LSM [95% CI], 101.8 [89.1 to 116.3] versus 132.8 [116.3 to 151.7] morphine milligram equivalents; LSM ratio relative to bupivacaine [95% CI], 0.77 [0.64 to 0.92]; P = 0.0018). The median time to first opioid consumption after surgery was longer for the liposomal bupivacaine group (median [interquartile range], liposomal bupivacaine, 4.2 hours [2.7 to 6.1]; bupivacaine, 3.6 hours [2.5 to 4.8]; P = 0.0127). Treatment-related adverse event incidence was similar between groups (liposomal bupivacaine: 3.5%; bupivacaine: 2.5%). Liposomal bupivacaine administered via adductor canal block for total knee arthroplasty was associated with concurrent reductions in pain and opioid consumption compared with bupivacaine during the first 96 hours after surgery.

PurposeQuadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) has demonstrated efficacy in postoperative pain management for laparoscopic nephrectomy patients. Liposomal bupivacaine, a novel sustained-release local anesthetic, provides analgesia lasting up to 72 hours. However, its analgesic effect in QLB-LSAL remains undetermined. This randomized controlled trial aimed to compare the postoperative analgesic efficacy of liposomal bupivacaine versus bupivacaine hydrochloride in patients receiving QLB-LSAL after laparoscopic nephrectomy.Patients and MethodsA total of 116 patients were scheduled to undergo elective laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to two groups in a 1:1 ratio. The liposomal bupivacaine group (n = 53) received a mixture of 10 mL of liposomal bupivacaine (133mg) and 10 mL of normal saline, totaling 20 mL, while the bupivacaine hydrochloride group (n = 53) received 20 mL of 0.375% bupivacaine hydrochloride. Post-surgical patient-controlled sufentanil analgesia was provided. The primary outcome was total morphine equivalent consumption within the first 48 hours postoperatively.ResultsThe total consumption of morphine equivalents within 48 hours postoperatively was significantly lower in the liposomal bupivacaine group than in the bupivacaine hydrochloride group (mean ± SD: 31.8 ± 2.3 vs 20.7 ± 2.8, 95% Confidence Intervals: 10.1 to 12.1, P < 0.001). The liposomal bupivacaine group demonstrated superior postoperative recovery quality (P < 0.05), exceeding the minimal clinically important difference, whereas no significant difference in the incidence of adverse events (P > 0.05) was observed between the two groups.ConclusionThe findings demonstrated that administration of liposomal bupivacaine in QLB-LASL significantly reduced postoperative opioid consumption while concurrently improving recovery quality in patients undergoing laparoscopic nephrectomy.

ObjectiveThis study aimed to evaluate and compare the analgesic efficacy of liposomal bupivacaine (LB) versus conventional bupivacaine hydrochloride for intercostal nerve block after thoracoscopic surgery.DesignA prospective, randomized, controlled, single-blind study.SettingThe study was conducted in the operating room, post-anesthesia care unit (PACU), and general ward.ParticipantsA total of 100 patients classified as ASA physical status II–III who were scheduled for thoracoscopic surgery were enrolled.InterventionsParticipants were randomly allocated to receive either LB or conventional bupivacaine hydrochloride via intercostal nerve block, performed under ultrasound guidance. All patients received intravenous patient-controlled analgesia (PCA) without a continuous background infusion. Rescue morphine was administered as needed if the PCA failed to provide adequate pain relief (VAS ≥ 4).MeasurementsThe primary outcome was postoperative pain intensity assessed using the Visual Analog Scale (VAS; 0–10) both at rest and during exercise at 6, 8, 12, 24, 48, and 72 h after surgery. Secondary outcomes included total morphine consumption, PCA demand frequency, patient satisfaction scores, intraoperative remifentanil dose, and length of hospital stay. Safety outcomes included the incidence of postoperative nausea and vomiting (PONV), pruritus, pulmonary complications, and cardiovascular events.ResultsBaseline characteristics and surgical procedures were comparable between groups. Compared with conventional bupivacaine, the LB group showed significantly lower VAS scores at rest and during exercise at all six postoperative time points (6–72 h; all p < 0.01). PCA demand frequency was significantly reduced in the LB group (median: 11 vs. 30 presses; p < 0.01). Patient satisfaction scores were significantly higher in the LB group (median: 9.0 vs. 7.0; p < 0.01). No significant differences were observed in intraoperative remifentanil consumption (p = 0.088) or postoperative hospital stay (p = 0.135). Rescue morphine requirements were minimal in both groups (median: 0 doses).ConclusionLB provided sustained and effective postoperative analgesia for 72 h after thoracoscopic surgery, while significantly reducing opioid consumption (p < 0.01) and supplemental analgesic requirements compared to conventional bupivacaine.Clinical trial registrationwww.chictr.org.cn, ChiCTR2300076708.