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David S. Ettinger, MD, FACP, FCCP


Role of Bupivacaine in Pain Management After Lobectomy for Early-Stage Lung Cancer

By: Vanessa A. Carter, BS
Posted: Thursday, February 24, 2022

Kanika Chawla, MD, of Southern Illinois University, Springfield, and colleagues conducted a trial to compare local infiltration of the anesthetic bupivacaine with epinephrine or liposomal bupivacaine in patients undergoing minimally invasive lobectomy for early-stage lung cancer. Presented during the 2022 Annual Meeting of The Society of Thoracic Surgeons (STS), these findings revealed that narcotic use was similar between patients treated with each type of anesthetic in terms of postoperative pain scores, length of stay, and duration of narcotic use.

“Given similar outcomes but a significant cost differential, our institution has transitioned to traditional bupivacaine,” concluded the study investigators.

This single-blinded study enrolled 45 patients undergoing minimally invasive lobectomy for early-stage lung cancer. Participants were randomly assigned to receive 0.25% bupivacaine with epinephrine (n = 21) or 1.3% liposomal bupivacaine (n = 24). Pain levels were documented using the visual analog scale, and narcotic pain medications were collected as morphine equivalents.

The mean patient age was 66, with most patients being non-Hispanic White (96%) and about half being female (56%). Baseline characteristics and comorbidities appeared to be similar between both cohorts. Although length of stay (2.78 vs. 3.28 days), duration of surgery (106 vs. 137 minutes), and chest tube duration (49 vs. 55 hours) appeared to be longer among patients given liposomal bupivacaine, the difference was found to be insignificant.

The in-hospital morphine equivalents of bupivacaine and liposomal bupivacaine were 43.4 mg and 51.5 mg, respectively, with median pain scores of 5.3 and 4.7 among patients on each anesthetic. No significant difference in narcotic use was found between patients given bupivacaine or liposomal bupivacaine 30 days (57.1% vs. 54.5%) or 6 months (5.9% vs. 9.5%) after surgery. Despite a similar overall cost ($20,251 vs. $22,686), the cost of liposomal bupivacaine at the pharmacy was significantly higher than traditional bupivacaine ($1,294 vs. $667; P = .0001).

Disclosure: For disclosures of the study authors, visit

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