Eastern Cardiothoracic Surgical Society

The Use of Liposomal Bupivacaine in Thoracic Surgery
Joseph D. Whitlark, Spencer M. Jackson. Thoracic & Vascular Associates of Kinston, Kinston, NC USA.

Objective: Liposomal Bupivacaine is a long acting local anesthetic agent which lasts between 72 to 96 hours after injection. It has been used widely in orthopedic surgery. We began using this in our thoracic surgery patients and noticed an improvement not only postoperatively but also long-term.

Methods: We retrospectively compared a group of 20 patients treated with intrathoracic intercostal nerve blocks using liposomal bupivacaine and compared this to 20 patients who had been blocked with just bupivacaine.

Results: What we found from analyzing these two groups of patients was that liposomal bupivacaine not only decreased length of stay but also decreased narcotic use postoperatively and after discharge.

Conclusions: This procedure is done intrathoracically and can be done quite quickly. A recent paper from MD Anderson Cancer Center shows no significant difference between intercostal Liposomal Bupivacaine blocks and thoracic epidurals. However, thoracic epidurals add time to the case and also had some issues such as urinary retention and hypotension postoperatively. We have found that the Liposomal Bupivacaine intercostal blocks are actually better from a pain control perspective. Not only are the cases shortened and postoperative management simplified, but we have found it better for long-term pain control.