Comparison of liposomal bupivacaine and bupivacaine hydrochloride intercostal nerve blocks for postoperative analgesia after thoracic surgery: a multicenter, randomized, three arms trial protocol

Whether intercostal nerve block can fully realize the prolonged analgesic potential of liposomal bupivacaine remains uncertain. This study aims to evaluate whether liposomal bupivacaine administered via intercostal nerve block confers a long-acting analgesic advantage over bupivacaine hydrochloride and no block within the postoperative 25–72 h window. This is a multicenter, randomized, parallel, three-arm controlled trial planning to enroll 210 patients undergoing elective unilateral video-assisted thoracoscopic surgery. Using center-stratified block randomization (1:1:1), patients will be allocated at the end of surgery to receive an intercostal nerve block with liposomal bupivacaine, bupivacaine hydrochloride, or no block. All patients will follow a standardized general anesthesia and multimodal analgesia protocol. The primary outcome is the area under the curve for pain scores during the postoperative 25–72 h. Other outcomes include pain verbal response scale at predefined time points, cumulative postoperative morphine milligram equivalent consumption, sensory block recovery time, 15-item quality of recovery scale, postoperative nausea and vomiting, postoperative pulmonary complications, length of hospital stay. This study prospectively evaluates the central question of whether liposomal bupivacaine confers a clinically meaningful long-acting analgesic advantage when used in the context of nerve block. By focusing on the area under the curve of pain scores and incorporating patient-centered outcomes such as opioid consumption and quality of recovery, the study aims to generate high-quality, translatable evidence to define the role of liposomal bupivacaine in thoracic surgery. Clinicaltrials.org, NCT07134660.