The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Abstract

Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

Effects of intraoperative liposomal bupivacaine on pain control and opioid use after pediatric Chiari I malformation surgery: an initial experience

“…In terms of opioid use, Tomov et al 14 noted a significant reduction within the immediate postoperative period in their spinal fusion cohort who were treated with LB, which corresponds to our findings within the first 24 postoperative hours. On the other hand, for multiple spinal fusion studies of LB analgesia, 12,14,19 the authors reported no difference in total opioid use by the time of discharge, which parallels our findings after the first 24 postoperative hours to discharge. In terms of pain scores, Brusko et al 13 showed in their spinal fusion cohort that the only significant difference between their LB and control cohorts was on the first postoperative day, with the LB cohort reporting lower scores, but this difference was no longer observed up until discharge, a trend that was also reported by Puffer et al, 19 and both studies ultimately mirror the experiences we report here for the use of LB for pain relief in pediatric patients undergoing Chiari decompression.…”

“…A primary concern surrounding the use of LB in a pediatric cohort is the risk of associated adverse events, particularly in cases in which the central nervous system is exposed to the drug. In large adult series, 9,12 the most common adverse events associated with LB in general are nausea, emesis, constipation, and hypotension events. More specific to neurosurgery and Chiari surgery, central nervous system toxicity has been reported.…”

“…[7][8][9] The novelty of LB lies in its multivesicular liposomal system, which results in a slower release of bupivacaine compared to the more standard liquid formulation and makes LB an attractive alternative for consideration to enhance the patient's postoperative course. 10 LB is an FDA-approved drug, 11 and although its safety in adults fol-lowing spine surgery has been demonstrated in multiple reported studies, [12][13][14] the safety and efficacy of LB in Chiari decompression surgery and pediatric patients have not been explored.…”

Postoperative pain treatment after spinal fusion surgery: a systematic review with meta-analyses and trial sequential analyses

“…For subgroup analyses, we identified 5 groups, which included 3 or more trials: nonsteroidal anti-inflammatory drugs (NSAIDs), 3 , 55 , 59 , 62 , 71 epidural analgesia, 2 , 7 , 21 , 32 , 60 ketamine infusion, 1 , 5 , 24 , 41 , 53 , 64 , 66 local infiltration analgesia, 6 , 22 , 44 , 61 and intrathecal (i.t.) morphine.…”

“…Four trials reported on local infiltration/wound analgesia and 24-hour opioid consumption. 6 , 22 , 44 , 61 The meta-analysis favored the control group and reported no significant reduction in opioid consumption 2 mg i.v. per 24 hours (95% CI: −5 to 10) with large heterogeneity I 2 = 98% (Fig.…”