Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for partial pneumonectomy, but postoperative pain remains a major challenge affecting recovery. Intercostal nerve block (ICNB) with conventional local anesthetics provides limited duration of analgesia, often insufficient to cover the peak pain period after surgery. Liposomal bupivacaine is a long-acting formulation designed to provide extended analgesia up to 72 hours. This study aims to evaluate the effect of preoperative ICNB with liposomal bupivacaine compared with conventional bupivacaine hydrochloride on postoperative quality of recovery in patients undergoing VATS partial pneumonectomy. The primary outcome is the Quality of Recovery-15 (QoR-15) score at 24 hours postoperatively. We hypothesize that liposomal bupivacaine ICNB results in superior recovery quality compared with conventional bupivacaine, with reduced postoperative pain and opioid consumption.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
96
Single-dose, pre-procedural intercostal nerve block with bupivacaine hydrochloride, administered by thoracoscopy prior to surgery.
Single-dose, pre-procedural intercostal nerve block with bupivacaine liposome, administered by thoracoscopy prior to surgery.
Postoperative Quality of Recovery at 24 hours
Quality of Recovery-15 (QoR-15) questionnaire. The scale includes 15 items across 5 domains: pain, physical comfort, physical independence, psychological support, and emotional state. Each item is scored from 0 to 10 (0 = worst possible recovery; 10 = best possible recovery). Total score ranges from 0 to 150, with higher scores indicating better recovery.
Time frame: 24 hours after surgery
Postoperative Quality of Recovery at 48 hours
Quality of Recovery-15 (QoR-15) questionnaire. The scale includes 15 items across 5 domains: pain, physical comfort, physical independence, psychological support, and emotional state. Each item is scored from 0 to 10 (0 = worst possible recovery; 10 = best possible recovery). Total score ranges from 0 to 150, with higher scores indicating better recovery.
Time frame: 48 hours after surgery
Area Under the Curve (AUC) of Pain Scores in the First 48 Hours
Pain intensity assessed using the Numerical Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). Assessments are performed at 0, 1, 3, 6, 12, 24, 36, and 48 hours after arrival in the post-anesthesia care unit (PACU), separately for pain at rest and pain during coughing (movement). AUC is calculated using the trapezoidal method.
Time frame: From PACU arrival to 48 hours post-PACU arrival (assessed at 8 time points)
Cumulative Morphine Consumption in the First 48 Hours
Total cumulative morphine consumption (in mg) recorded from the patient-controlled analgesia (PCA) device during the first 48 hours after surgery.
Time frame: First 48 hours after surgery
Time to First PCA Demand
Time interval from arrival in the post-anesthesia care unit (PACU) to the first demand dose of patient-controlled intravenous analgesia (PCIA).
Time frame: Up to 48 hours
Patient Satisfaction
Patient satisfaction with postoperative analgesia assessed using a 5-point Likert scale: 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied.
Time frame: 48 hours after surgery
Duration of PACU Stay
Time interval from arrival in the post-anesthesia care unit (PACU) until the Aldrete score reaches ≥9.
Time frame: From PACU arrival to Aldrete score ≥9, up to 1 hour
Emergence time
Time interval from discontinuation of anesthetic agents until the patient shows a purposeful response to verbal command.
Time frame: Up to 1 hour
Intraoperative Remifentanil Consumption
Total intraoperative remifentanil consumption (in μg) from the start of anesthesia maintenance until the end of surgery.
Time frame: Intraoperative period (from anesthesia maintenance initiation to end of surgery)
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