The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Luke Brown; Tristan Weir; Mark Shasti; Omer Yousaf; Imran Yousaf; Oliver Tannous; Eugene Koh; Kelley Banagan; Daniel Gelb; Steven Ludwig

doi:10.14444/5052

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 = .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 = .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.

Footnotes

Disclosures and COI: LB/TW/MS/OY/IY/OT: No disclosures. SL: American Board of Orthopaedic Surgery, Inc. Board or committee member, American Orthopaedic Association: Board or committee member. AO Spine North America Spine Fellowship Support: Research support. ASIP, ISD: Stock or stock Options. Cervical Spine Research Society: Board or committee member. DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker. Globus Medical: Paid consultant; Research support. Journal of Spinal Disorders and Techniques: Editorial or governing board. K2M spine: Research support. K2Medical: Paid consultant. OMEGA: Research support. Pacira: Research support. SMISS: Board or committee member. Synthes: Paid consultant; Paid presenter or speaker. Thieme, QMP: Publishing royalties, financial or material support. DG: Advanced Spinal Intellectual Property: Stock or stock options. Depuy-Synthes Spine: IP royalties; Paid presenter or speaker. Globus Medical: IP royalties. EK: Biomet: Paid consultant. DePuy, A Johnson & Johnson Company: Paid presenter or speaker. KB: K2M: Employee. Orthofix, Inc.: Research support. Institutional review board approval was obtained before conducting this research study. Funding: This study was funded by Pacira Pharmaceutical, Inc.