探讨布比卡因脂质体在超声引导下腹横肌平面阻滞（TAPB）中对开放无张力腹股沟疝修补术（Lichtenstein术）术后镇痛的有效性及安全性。

采用前瞻性、单中心、随机、双盲、阳性对照临床试验，将2024年5月至2025年3月于天津市南开医院胃肠外科二行单侧Lichtenstein手术的患者82例，采用区组随机化方法分为A组（灭菌注射用水20 ml）、B组（7.5 mg/ml盐酸布比卡因10 ml＋生理盐水10 ml）、C组（13.3 mg/ml布比卡因脂质体10 ml＋灭菌注射用水10 ml）。术后第1、2、3、4、5、6、8、10、12、24、36、48、72和96 h 14次评估患者的静息疼痛（采用数字评定量表法）并绘制疼痛曲线，比较术后0~96 h疼痛评分的累积负担[曲线下面积（AUC）]、阿片类药物用量及不良反应发生情况。

3组患者术前一般资料比较，差异均无统计学意义（P>0.05）。C组AUC（172.18）显著小于A组（233.42，P<0.001）及B组（228.90，P<0.001），而A、B组间AUC差异无统计学意义（P=0.752）。3组患者中C组补偿用药率最低，差异有统计学意义（P<0.05），C组首次补偿用药时间显著长于A组、B组，C组术后疼痛控制效果更优，无需补偿用药的比例更高。3组患者术后镇痛的不良反应发生情况比较，差异无统计学意义（P>0.05）。

术前采用布比卡因脂质体行超声引导下TAPB可有效缓解开放无张力疝修补术后疼痛，效果优于传统布比卡因，且安全性相当。

To evaluate the efficacy and safety of liposomal bupivacaine for postoperative analgesia in patients undergoing open tension-free inguinal herniorrhaphy (Lichtenstein repair) via ultrasound-guided transversus abdominis plane block (TAPB).

A prospective, single-center, randomized, double-blind, positive-controlled clinical trial was conducted. Eighty-two patients scheduled for unilateral Lichtenstein herniorrhaphy in the Second Department of Gastrointestinal Surgery, Tianjin Nankai Hospital between May 2024 and March 2025 were enrolled. Using block randomization, patients were assigned to one of three groups: Group A (20 ml sterile water for injection), Group B (10 ml 7.5 mg/ml hydrochloride bupivacaine+10 ml normal saline), and Group C (10 ml 13.3 mg/ml liposomal bupivacaine+ 10 ml sterile water for injection ). Resting pain scores (using the numeric rating scale method) were assessed 14 times at 1, 2, 3, 4, 5, 6, 8, 10, 12, 24, 36, 48, 72, and 96 hours postoperatively, and pain profiles were plotted. The cumulative burden of pain scores [area under the curve (AUC)], opioid drugs consumption, and incidence of adverse reactions during the 0-96-hour postoperative period were compared.

No statistically significant differences were observed in preoperative general characteristics among the three groups (P>0.05). The AUC in Group C (172.18) was significantly lower than that in Group A (233.42, P<0.001) and Group B (228.90, P<0.001), whereas no significant difference was found between Group A and Group B (P=0.752). Among the three groups of patients, Group C had the lowest rescue medication rate, with a statistically significant difference (P<0.05). The time to first rescue medication in Group C was significantly longer than that in Groups A and B. Group C had better postoperative pain control effect, and a higher proportion of patients did not require rescue medication. The incidence of postoperative analgesic-related adverse events has no significant difference among the three groups (P>0.05).

Preoperative administration of liposomal bupivacaine under ultrasound- guided TAPB effectively alleviates pain after open tension-free herniorrhaphy, with superior efficacy compared to conventional bupivacaine and a comparable safety profile.