Impact of intercostal nerve blocks using liposomal versus standard bupivacaine on length of stay in minimally invasive thoracic surgery patients

Background: Postsurgical pain control can have a significant impact on patient outcomes and hospital-associated costs. We sought to evaluate the effect of intercostal nerve blocks using liposomal bupivacaine on length of stay (LOS) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: We retrospectively reviewed outcomes in 80 patients undergoing VATS wedge resection, VATS lobectomy, or minimally-invasive esophagectomy (MIE). Patients received either liposomal bupivacaine (n=40) or standard-release bupivacaine with epinephrine (n=40) via intercostal nerve block. The LOS, 24-hour postoperative pain scores, overall opioid usage, and patient ambulation rates at 24 hours were compared for the two groups. Results: The median LOS was significantly shorter in patients receiving liposomal bupivacaine, at 1.35 days (IQR, 1.28 to 1.53 days) compared to 2.45 days (IQR, 2.08 to 3.51 days) in patients receiving standard-release bupivacaine (P<0.0001). Average post-operative pain score during the first 24 hours was 3.4 +/- 1.8 for the liposomal bupivacaine group and 2.3 +/- 1.2 for the control group (P=0.002). This difference, though statistically significant, is likely not clinically significant, as there was no difference in 24-hour postoperative intravenous morphine equivalent usage between the liposomal bupivacaine and control groups (29.8 +/- 21.0 vs. 31.9 +/- 20.9 mg, respectively, P=0.664). Interestingly, however, 93% (37/40) of patients receiving liposomal bupivacaine were able to ambulate within 24-hours after surgery, compared to 65% (26/40) of patients in the control group (P=0.003). Conclusions: The use of liposomal bupivacaine is associated with decreased LOS in postoperative thoracic surgery patients and earlier return to ambulation. It does not, however, decrease 24-hour postoperative pain scores or opioid usage.