Liposomal Bupivacaine: A Boon or Bane for Postlobectomy Pain Management?

We thank Drs Kuckelman and Miller 1 Kuckelman J. Miller D. Importance of technique for thoracic field block using expanded liposomal bupivacaine. Ann Thorac Surg. 2023; 116: 654 Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their thoughtful comments on our paper in The Annals of Thoracic Surgery. 2 Thuppal S. Sleiman A. Chawla K. et al. Randomized trial of bupivacaine versus liposomal bupivacaine in minimally invasive lobectomy. Ann Thorac Surg. 2022; 114: 1128-1134 Abstract Full Text Full Text PDF Scopus (4) Google Scholar Regarding the concern for adequate dilution of liposomal bupivacaine (LipoB), as we were developing this protocol the dilution of LipoB was evolving within the literature, with many investigators reporting the use of the standard volume of LipoB without dilution. We were sensitive to these changes, although one could consider this a moving target that allows proponents of LipoB to refute any previous data that do not support the desired narrative for LipoB. As a compromise, we routinely diluted the LipoB with normal saline to achieve a similar volume to that of the regular bupivacaine cohort (50-60 mL) that allowed for ample volume to perform a multilevel thoracic field block. Importance of Technique for Thoracic Field Block Using Expanded Liposomal BupivacaineThe Annals of Thoracic SurgeryVol. 116Issue 3PreviewWe commend Dr Thuppal and colleagues1 on their evaluation of the effect of intercostal liposomal bupivacaine (“Lipo-B”) compared with bupivacaine in narcotic-naive minimally invasive lobectomy patients. They found no differences in outcomes between their randomized groups. The importance of this type of work cannot be understated. It is incumbent that the reader interprets these results with a few critical reservations. Full-Text PDF