215. Randomized Trial of Intercostal Nerve Block with Bupivacaine with Epinephrine Versus Bupivacaine Liposome Suspension in Patients Undergoing Minimally Invasive Lung Resection
*Benny Weksler1, Jennifer L. Sullivan2, Lana Y. Schumacher1
1Allegheny General Hospital, Pittsburgh, PA; 2Meridian Health, Brick, NJ
Invited Discussant: *Sudish C. Murthy
Objective: Thoracic surgery can cause significant pain. Multiple strategies have been developed to improve pain control after surgery. The goal of this study was to compare two bupivacaine formulations given intraoperatively for pain control: bupivacaine with epinephrine (1:200,000; BE), which cost $6 or less, or liposomal bupivacaine (BL), which cost $285.
Methods: This is a randomized, open-label study (NCT03560362). Eligible patients were older than 18 years and scheduled for a minimally invasive lung procedure. Chronic narcotic users and patients with fibromyalgia or significant liver or kidney disease were excluded. Incision sites were infiltrated with BE or BL prior to incision. All patients received 1 ml BE or BL in each intercostal space at the beginning of the operation and patient-controlled analgesia (PCA) starting in the recovery room. All narcotics administered were converted to morphine-equivalent dose. Pain was recorded using a Visual Analog Scale (VAS). Primary outcome was the amount of PCA administered.
Results: We recruited 50 evaluable patients; 25 received BE, and 25 received BL. The treatment groups were similar in age, sex, race, histology, and procedure performed (lobectomy, segmentectomy, or wedge resection). There were no differences between the treatment groups in use of narcotics via PCA, or in pain 1 day postoperatively, at first postoperative visit (~2 weeks postoperatively), or 3 months postoperatively, which was assessed as a secondary outcome using VAS (Table 1). Hospital length of stay and complications were similar between patients who received BE and patients who received BL. There were no side effects related either intercostal pain blocking agent.
Conclusions: In a small randomized study, we did not find significant differences between BE and BL in mitigating pain after minimally invasive lung resection. Until further studies demonstrate otherwise, we suggest using the least expensive available formulation of bupivacaine, which currently is BE.
Age, median in years (range)
Male sex, n (%)
Lobectomy or segmentectomy, n (%)
Primary lung cancer, n (%)
Length of stay, median in days (range)
MED (median, range)
VAS day 1
VAS 2 weeks
MED=morphine equivalent dose
VAS - Visual analog scale