布比卡因脂质体在心胸外科围术期镇痛中的应用进展

Advances in the application of liposomal bupivacaine in perioperative analgesia for cardiothoracic surgery

摘要

心胸外科手术创伤较大，术后疼痛管理是围术期治疗的重要环节。传统区域阻滞技术因单次给药时效较短或硬膜外置管相关并发症，难以有效覆盖术后24~72 h的重度疼痛高峰期。布比卡因脂质体(liposomal bupivacaine，LB)采用多囊脂质体缓释技术，可将单次给药的镇痛效果延长至72 h，为减少导管相关并发症、优化区域镇痛方案提供了新的技术选择。文章系统综述了LB在心胸外科领域的药理机制及临床应用进展。分析表明，LB的核心临床价值在于通过单次给药实现长效镇痛，替代连续导管技术以减少置管相关并发症，并作为多模式镇痛的重要组分发挥阿片节俭效应。同时，探讨其在复杂手术中绝对镇痛强度可能不足的争议、物理弥散局限及卫生经济学挑战，以期为临床合理应用提供参考。

Abstract

Cardiothoracic surgery is associated with significant trauma，making effective postoperative pain management critical for enhanced recovery. Traditional regional analgesia is often limited by the short duration of single-dose local anesthetics or complications associated with continuous catheter techniques，which can hinder effective pain control during the intense 24-72 h postoperative period. Liposomal bupivacaine(LB)，a multivesicular liposome formulation of bupivacaine，provides a single-dose analgesic effect lasting up to 72 h. This extended-release profile offers a novel，catheter-free approach to regional analgesia，with the potential to reduce catheter-related complications and serve as a key component of multimodal analgesia. This review systematically summarizes the pharmacological mechanisms and clinical applications of LB in cardiothoracic surgery. The evidence indicates that LB enables prolonged analgesia with a single dose，replacing continuous catheter techniques to mitigate catheter-associated complications，and exerting an opioid-sparing effect as a key component of multimodal analgesia. Meanwhile，this paper discusses ongoing controversies，including its comparative analgesic efficacy against established techniques like thoracic epidural analgesia，limitations due to its physical properties affecting tissue spread，and challenges related to its cost-effectiveness in different healthcare systems，so as to provide evidence-based references for rational clinical utilization.

关键词

布比卡因脂质体 / 心胸外科 / 多模式镇痛 / 区域阻滞

Key words

liposomal bupivacaine / cardiothoracic surgery / multimodal analgesia / regional block

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基金资助

中华国际医学交流基金会中青年研究专项基金(Z-2018-35-2101)