Abstract
OBJECTIVE: To assess the immunomodulatory and analgesic effects of liposomal bupivacaine compared to ropivacaine on erector spinae plane block (ESPB) for patients undergoing thoracoscopic lung cancer surgery. METHODS: This retrospective study included 260 patients undergoing thoracoscopic lung cancer surgery. Patients were divided into two groups based on anesthesia methods: the liposomal bupivacaine group (n = 134) and the ropivacaine group (n = 126). Both groups received general anesthesia followed by ESPB. Perioperative inflammatory markers (IL-6, TNF-α, CRP), immunoglobulins (IgA, IgG, IgM), and analgesic outcomes (Numerical Rating Scale (NRS) scores) were measured at various postoperative time points. Cellular inflammatory markers, including white blood cell (WBC) counts and neutrophil percentages, were also assessed. Tumor markers (galectin-3 (Gal-3), carbohydrate antigen 125 (CA125), cytokeratin 21-1 fragment (CY-FRA21-1), soluble programmed death ligand-1 (sPD-L1)) were analyzed at 3-month follow-up. RESULTS: The liposomal bupivacaine group exhibited significantly reduced inflammatory responses with lower levels of IL-6 (P = 0.005), TNF-α (P = 0.007), and CRP (P = 0.01) at 12-72 hours postoperatively. Immunoglobulin levels were better preserved in this group (IgA P = 0.007, IgG P = 0.016, IgM P = 0.033). Analgesia outcomes were superior, with lower NRS scores at 36 h (P = 0.002) and 72 h (P = 0.006). Cellular inflammatory markers, including WBC counts and neutrophil percentages, were also significantly reduced (P < 0.05). At the 3-month follow-up, the liposomal bupivacaine group showed significantly lower levels of tumor markers, particularly sPD-L1 (all P < 0.001). CONCLUSIONS: Liposomal bupivacaine for ESPB enhances both immunoprotective effects and postoperative analgesia in thoracoscopic lung cancer surgery.