Analgesia for Video-assisted Thoracoscopic Surgeries: A Comparison Between Intercostal Blocks With Liposomal Bupivacaine and Paravertebral Blocks With Plain Bupivacaine

  • End date
    Jul 31, 2024
  • participants needed
  • sponsor
    Rakesh Sondekoppam Vijayashankar
Updated on 18 October 2022


Video-assisted thoracoscopic surgery (VATS) greatly decreased the number and types of surgery that required open thoracotomy. Initially it was thought that VATS would lead to a reduction of respiratory problems and less acute pain in patients when compared to patients receiving an open thoracic surgery. However, for reasons not clearly understood, a large number of patients who undergo VATS still experience moderate to severe post-surgical pain (1). Physicians are still faced with the challenge of providing care that will manage both the respiratory issues as well as manage acute pain. The goal of this study is to find the most suitable regimen to effectively manage post-VATS-related pain.


The "promise" was that video-assisted thoracoscopic surgery (VATS) would be associated with less severe pulmonary impairment and less acute post-operative pain compared to open thoracotomy. However, VATS can cause moderate to severe post-operative pain in a significant number of patients and the reason for this is not well understood. In addition it has been found that post-surgical pain can be a strong predictor for the development of chronic pain. Inadequate control of acute pain not only causes serious discomfort and significant respiratory problems, but it may place this population of patients at greater risk of chronic pain and prescription opioid dependence.

Current protocols to manage and/or reduce VATS associated pain include combining the use of regional anesthesia techniques with opioid and non-opioid analgesics. Recent studies have investigated the efficacy of intercostal blocks using liposomal bupivacaine after thoracic surgery. However, these studies lacked an active comparator population of patients.

The study is designed as a prospective randomized study evaluating intercostal blocks using liposomal bupivacaine. The control population of patients will be treated with a paravertebral block using plain bupivacaine.

Condition Pain, Postoperative
Treatment Liposomal bupivacaine, Bupivacaine
Clinical Study IdentifierNCT04864210
SponsorRakesh Sondekoppam Vijayashankar
Last Modified on18 October 2022


Yes No Not Sure

Inclusion Criteria

Age over 18 years and less than 80 years
Undergoing video-assisted thoracoscopic surgery (VATS) procedure
BMI less than 40

Exclusion Criteria

Unable to provide informed consent
Non-English speaking
BMI greater than 40
Video-assisted thoracoscopic surgery pleurodesis subjects
Patients with pre-existing chronic pain
Opioid tolerance
Pain syndromes including fibromyalgia, regional pain syndrome or post therapeutic neuralgia in a thoracic distribution
Allergy to the study medication
Patients with infectious disease
Patients with impaired coagulation
Severe hepatic disease
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