Comparison of Liposomal Bupivacaine versus Bupivacaine in Superficial Parasternal Intercostal Plane Block for Cardiac Surgery with Median Sternotomy.

PURPOSE: This study aimed to compare the efficacy and safety of liposomal bupivacaine (Lip-BPVC) versus standard bupivacaine (BPVC) for superficial parasternal intercostal plane block in patients undergoing elective coronary artery bypass grafting (CABG) via median sternotomy. METHODS: A total of 82 adult patients were randomly assigned to the BPVC group (n = 41) or the Lip-BPVC group (n = 41). RESULTS: The Lip-BPVC group demonstrated significantly lower pain scores at all postinjection time points compared to the BPVC group with fewer opioid analgesics. Lip-BPVC demonstrated an initial heightened inflammatory response postoperatively compared to standard BPVC, indicated by significantly lower levels of pro-inflammatory markers at 24 and 48 hours postinjection with BPVC. However, by 72 hours, inflammatory markers did not differ significantly between Lip-BPVC and BPVC groups. No significant differences were observed between the groups in terms of surgery duration, extubation time, intensive care unit and hospital length of stay, or incidence of postoperative nausea and vomiting. CONCLUSIONS: Lip-BPVC initially increased inflammatory markers postoperatively, but levels were comparable to BPVC by 72 hours. It provided superior pain control and reduced opioid use compared to standard BPVC in CABG patients, with similar safety and recovery outcomes.