Liposomal bupivacaine may augment pain management for spinal fusion
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Key takeaways:
- Liposomal bupivacaine was associated with less required opioids after spinal fusion vs. a control group.
- Length of stay, use of antiemetics and urinary retention was statistically similar between the groups.
Results showed patients who received liposomal bupivacaine for pain management during open posterior lumbar decompression and fusion required less opioids during their hospital stay vs. patients who did not receive the anesthetic.
Researchers performed a single-center, single-surgeon retrospective chart review of data from 198 patients who underwent open posterior lumbar laminectomy and fusion. Researchers compared results from a treatment group of 99 patients (mean age, 64.3 years) who received intraoperative liposomal bupivacaine and a matched control group of 99 patients (mean age, 65.7 years) who did not receive liposomal bupivacaine during surgery.
Postoperative outcome measures included required opioids measured in morphine milligram equivalents (MMEs), as well as length of stay, antiemetics and urinary retention.
Overall, patients in the liposomal bupivacaine group consumed significantly fewer mean MMEs per minute (0.024 vs. 0.042) and used significantly less mean postoperative oxycodone (48.9 vs. 70.9) compared with the control group.
Mean length of stay was approximately 3,097 minutes for the liposomal bupivacaine group and approximately 3,424 minutes for the control group; however, researchers noted the difference was not statistically significant. Researchers also noted no significant differences in urinary retention or antiemetic use between the groups.
“With an approximate 57% reduction in hospital postoperative opioid consumption with the use of local wound infiltration of liposomal bupivacaine, this treatment strategy has immediate individual patient benefits and supports nationwide efforts to address the opioid crisis,” the researchers wrote.
Perspective
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This study is a comparison of an effective blockade technique for postoperative pain control vs. a historical control group. Erector spinae blocks are quite effective in pain control after lumbar surgery. I cannot help but wonder if the study would have even more useful results if the comparison was non-liposomal bupivacaine to the liposomal bupivacaine. At our institution, the anesthesiologists use bupivacaine in combination with Depo-Medrol (Pfizer), which appears to enhance efficacy.
As we are now in an era of value-based care, these incredible interventions should not necessarily be compared to historical controls (ie, narcotic treatment) but rather alternative medications (bupivacaine/Depo-Medrol) and studied by independent investigators with attention to overall cost, taking into account cost and savings simultaneously.
I congratulate the authors on this important contribution and look forward to future work clarifying the best blockade agent that is also the most cost-effective for our patients and health care systems.
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