• Jacklynn F Sztain, Rodney A Gabriel, and Engy T Said.
• Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, La Jolla, CA.
• J. Cardiothorac. Vasc. Anesth. 2019 Mar 1; 33 (3): 694-698.

ObjectiveThoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control in thoracic surgery, however it is associated with the undesirable risks of hypotension urinary retention, and bleeding. Recently, surgical site infiltration with liposomal bupivicaine (LB) has been suggested as a comparable alternative to TEA. The authors compared total opioid consumption in patients who received either TEA or LB undergoing video-assisted thorascopic surgery (VATS) for lobectomy.DesignRetrospective cohort study.SettingUniversity hospital.ParticipantsPatients undergoing VATS for lobectomy.InterventionsTEA versus LB MEASUREMENTS AND MAIN RESULTS: The primary outcome was POD 0 to 2 total opioid requirements, measured in intravenous morphine equivalents (mg). Wilcoxon rank sum test was used to calculate the significant differences in the primary outcome. The 25 - 75% interquartile range (IQR) was reported with each median value. Forty-five patients were included in the analysis, in which 14 (31.1%) were in the LB group. Between the TEA and LB group, there were no differences in age, sex, or body mass. The median (25 - 75% IQR) total opioid consumption during POD 0 - 2 in the TEA and LB group were 28.0 mg (12.0 - 52.0 mg) and 49.5 mg (35.0 - 70.5 mg), respectively (p  =  0.03), in which the median difference was 22.5 mg (95% CI 0.60 - 38.0 mg).ConclusionsVATs lobectomy patients consumed 43.4% less opioids on POD 0-2 with TEA when compared to surgical site infiltration of LB. Further prospective randomized controlled trials are required to demonstrate superior analgesia of TEA in this surgical population.Copyright © 2018 Elsevier Inc. All rights reserved.

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