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We read with interest the research letter by Patel et al evaluating outcomes before and after the removal of liposomal bupivacaine from a health-system formulary for patients undergoing video-assisted thoracoscopic (VATS) wedge resection.1 The authors should be commended for leveraging a real-world formulary change, applying appropriate regression and interrupted time-series methods, and focusing on a relatively homogeneous surgical population. Their conclusion, that the removal of liposomal bupivacaine did not adversely affect the length of stay (LOS) or short-term outcomes, contributes meaningful evidence to ongoing discussions on value-based perioperative analgesia. A few inherent challenges of retrospective formulary-change analyses, however, warrant consideration to strengthen interpretation and guide future evaluations.