The Role of Liposomal Bupivacaine in Reduction of Postoperative Pain After Transforaminal Lumbar Interbody Fusion: A Clinical Study

Kim, Jackson; Burke, Shane M.; Kryzanski, James; Roberts, Russel J.; Roguski, Marie; Qu, Evan; Hwang, Steven W.; Liu, Penny P.; Desilier, Adriana; Riesenburger, Ron I.

doi:10.1016/j.wneu.2016.04.058

Cited by 27 publications

(33 citation statements)

References 40 publications

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“…Besides the technique aspect, regional long-acting analgesia (i.e., Exparel) and a significantly shorter operation time (mean operative time 110 minutes) were also demonstrated to be extremely helpful in reducing patients' pain levels. 24,25 In return, our patients in the ERAS program required less opioid consumption, and achieved early mobility.…”

Section: Discussionmentioning

confidence: 77%

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Chang

Huang

et al. 2020

Neurospine

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The concept of enhanced recovery after surgery (ERAS) is relatively new to the neurosurgical field. The introduction of an ERAS protocol in lumbar fusion surgery has aimed to accelerate patient recovery from surgery by reducing in-hospital opioid consumption. Methods: Patients with 1-or 2-level degenerative lumbar spine disease and who underwent ERAS transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. Patients' general demographic data, in-hospital opioid dosage (converted to morphine equivalents), and hospital stay were compared to those who underwent standard minimally-invasive (MIS)-TLIF. Results: Twenty-four patients who received ERAS TLIF (the ERAS group) were compared to a series of 24 patients who received standard MIS-TLIF (the MIS group). The demographic data were similar. The operation time and blood loss significantly favored ERAS TLIF. The average daily opioid consumption was remarkably lower in the ERAS group than the MIS group. Average opioid dosage throughout the entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group. The average length of hospital stay was substantially shorter in the ERAS group (1.4 ± 1.13 days vs. 4.0±1.98 days, p<0.001). Conclusion: The present study demonstrated a significant decline in the consumption of opioids and in the hospital length of stay for patients undergoing ERAS TLIF for 1-or 2-level degenerative lumbar spine disease.

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Section: Discussionmentioning

confidence: 77%

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Chang

Huang

et al. 2020

Neurospine

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“…Moreover, routine use of bupivacaine hydrochloride may be applicable in a variety of practice settings. 10,17 Many studies have demonstrated the benefits of NSAID use in the postoperative period with respect to decreasing opioid use and opioid-related side effects. 3 Sedation, constipation, ileus, and respiratory depression are serious opioid-related side effects that can extend the recovery period and hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Kılıç¹,

Demirbilek

Naderi

2019

Neurosurgical Focus

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OBJECTIVEEnhanced recovery after surgery (ERAS) is a multimodal approach that aims to improve perioperative surgical outcomes. The aim of this study was to evaluate the benefits of ERAS in terms of cost-effectiveness and postoperative outcomes in single-level lumbar microdiscectomy.METHODSThis study was a single-center retrospective comparing costs and outcomes before and after implementation of the ERAS pathway. Data were collected from the electronic medical records of patients who had undergone single-level lumbar microdiscectomy during 2 time periods—during the 2 years preceding implementation of the ERAS pathway (pre-ERAS group) and after implementation of the ERAS pathway (ERAS group). Each group consisted of 60 patients with an American Society of Anesthesiologists (ASA) Physical Status Classification of class 1. Patients were excluded if their physical status was classified as ASA class II–V or if they were younger than 18 years or older than 65.Groups were compared in terms of age, sex, body mass index (BMI), perioperative hemodynamics, operation time, intraoperative blood loss, intraoperative fluid administration, intraoperative opioid administration, time to first oral intake, time to first mobilization, postoperative nausea and vomiting (PONV), difference between preoperative and postoperative visual analog scale (VAS) scores, postoperative analgesic requirements, length of hospital stay, and cost of anesthesia.RESULTSThe ERAS and pre-ERAS groups were comparable with respect to age, sex, and BMI. Operation time, intraoperative blood loss, intraoperative opioid administration, and intraoperative fluid administration were all less in the ERAS group. First oral intake and first mobilization were earlier in the ERAS group. The incidence of PONV was less in the ERAS group. Postoperative analgesic requirements and postoperative VAS scores were significantly less in the ERAS group. The length of hospital stay was found to be shorter in the ERAS group. The ERAS approach was found to be cost-effective.CONCLUSIONSERAS had clinical and economic benefits and is associated with improved outcomes in lumbar microdiscectomy.

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“…They found that even though patients who received LB collectively spent less time on IV narcotics, this did not translate into a reduction in total MME or VAS pain scores in the postoperative period. However, Kim et al 27 revealed that LB significantly reduced patient pain scores and opioid consumption only in the first 24 hours following transforaminal lumbar interbody fusion surgery.…”

Section: Efficacy Of Liposomal Bupivacaine In Lumbar Spine Surgerymentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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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.

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The Role of Liposomal Bupivacaine in Reduction of Postoperative Pain After Transforaminal Lumbar Interbody Fusion: A Clinical Study

Cited by 27 publications

References 40 publications

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

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