Local Anesthetic as Single Shot Versus Catheter in Patients Undergoing Video Assisted Thoracoscopic Surgery

Single Shot Liposomal Bupivacaine (EXPAREL®)/Bupivicaine) Versus Continuous Erector Spinae Plane Block Catheter in Patients Undergoing Video Assisted Thoracoscopic (VAT) Surgery; Single Center, Non Inferiority, Open Label, Randomized Trial

The purpose of this research is to compare a single shot long acting local anesthetic to catheter infusion of local anesthetic in patients undergoing video assisted thoracoscopic (VAT) surgery.

The purpose of this research is to compare Single Shot Liposomal Bupivacaine (EXPAREL®)/Bupivacaine (a long acting local anesthetic) to Ropivacaine (0.5% bolus followed by 0.2% infusion of local anesthetic using a catheter) in patients undergoing video assisted thoracoscopic (VAT) surgery.

Inclusion Criteria:

• Subjects who are age > 18, undergoing video thoracoscopic surgery and following Guthrie Robert Packer Hospital's Enhanced Recovery After Surgery (ERAS) protocol for Thoracic Surgery.

Exclusion Criteria:

• weight < 50 kg, pregnant subjects,
• left ventricular ejection fraction < 30%,
• history of drug or narcotic abuse,
• history of allergic to amide local anesthetic,
• presence of contraindication for erector spinae plane block (local skin infection, sepsis, severe coagulopathy)
• unable to provide consent,
• unable to use pain rating scales as demonstrated by verbal feedback
• preoperative chronic pain on narcotics,
• history of renal insufficiency ( Creatinine > 1.5 mg/dl),
• preoperative mild liver impairment ( i.e. AST/ALT above 1.5 times the upper normal limit)