Intramuscular Liposomal Bupivacaine Decreases Length of Stay and Opioid Usage Following Lumbar Spinal Fusion

Abstract

Study Design: A retrospective cohort review. Objectives: The objective of this study was to investigate the efficacy of liposomal bupivacaine (LB) in patients undergoing lumbar spinal fusion. Summary of Background Data: Historically, posterior spinal fusion has been recognized as a particularly painful surgery. Postoperative pain limits early patient mobilization and discharge, and negatively impacts patient satisfaction. Local infiltration of anesthetic agents combined with postoperative multimodal pain management is common. On the basis of existing data, the liposomal formulation of bupivacaine might play a role in promoting faster recovery during the immediate postoperative period. The purpose of this study was to investigate the potential impact of LB on postoperative opioid requirements, ambulation, and duration of hospital stay, as well as potential health care cost savings. Materials and Methods: A historical cohort of adult lumbar spinal fusion patients was retrospectively evaluated, in which 105 patients received nonliposomal anesthetic and 105 received LB. Both groups were managed with a standardized postoperative analgesia regimen. Demographic information, opioid consumption, length of stay, distance ambulated, and total cost of inpatient stay were collected. Results: Although there was no difference in the pain scores between the 2 groups, the LB group was associated with significantly lower opioid usage throughout the postoperative period. More patients in the LB group were discharged within 2 days of surgery compared with the control group (88.6% vs. 38.1%, P<0.05). The control group was able to walk for a longer median distances (175 vs. 150 ft, P=0.02) on the first attempt, however, a significantly larger proportion of the LB group walked within the first 12 hours after surgery (61% vs. 3%, P<0.001). Also, LB usage was associated with $218 higher pharmacological cost compared with the control group but an overall $3035 lower cost for the entire hospitalization (P<0.001). Conclusion: Adjunctive usage of LB with lumbar fusion surgeries promotes earlier mobility, lower opioid consumption, and shorter length of stay resulting in overall lower health care cost. Level of Evidence: Level III.

The Effects of Liposomal Bupivacaine on Long-term Outcomes and Decreasing Immediate Postoperative Opioid Use Following One-level and Two-level Posterior Lumbar Fusions

“…14,26,37,40 Despite its higher cost, 2 studies comparing LB and a nonliposomal local anesthetic in lumbar fusion surgery demonstrated overall health care cost savings when utilizing LB. 40,43 These cost savings were most likely because of both studies finding a significant decrease in LOS for patients that received LB. Another retrospective study comparing the efficacy of bupivacaine alone versus LB when managing posterior cervical and lumbar decompression and fusions found that patients receiving bupivacaine alone required approximately twice the number of narcotics in the perioperative period compared with the LB cohort.…”

“…The cost of a 20 ml (266 mg) vial of LB is usually between $280 and $350, while the cost of using bupivacaine alone is typically between $2 and $8 14,26,37,40. Despite its higher cost, 2 studies comparing LB and a nonliposomal local anesthetic in lumbar fusion surgery demonstrated overall health care cost savings when utilizing LB 40,43. These cost savings were most likely because of both studies finding a significant decrease in LOS for patients that received LB.…”

“…Studies investigating its use in spine surgery been inconclusive with limited studies demonstrating varying results. 14,[38][39][40][41][42][43] This study aims to determine the efficacy of LB in postoperative analgesia in patients undergoing one-level and two-level instrumented posterior lumbar fusion surgery and report any adverse outcomes or complications that may be specific to its use around the lumbosacral spine. Potential benefits of its use include decreasing the consumption of opioids, earlier mobilization, decreased hospital costs, decreased LOS, and improved long-term outcomes.…”

“…The use of LB in spine surgery has not yet achieved the amount of high-quality research as it has had in TKA. Studies investigating its use in spine surgery been inconclusive with limited studies demonstrating varying results 14,38–43…”

The Role of Liposomal Bupivacaine in Multimodal Pain Management Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…Liposomal bupivacaine (LB) is a long-acting multivesicular formation of the local anesthetic that allows for prolonged release over several days 9 . It has been shown to be effective in decreasing postoperative opioid requirements and improving postoperative pain in adults who undergo orthopedic and spine procedures when used at the time of surgery 10–13 . It also has been safely used in the pediatric population and recently gained FDA approval 14,15 .…”