Liposomal Bupivacaine Reduces Narcotic Consumption in Adult Deformity Surgery

2018

Summary

90 adults undergoing surgery for scoliosis or kyphosis were given peri-incisional liposomal bupivacaine and compared with a control group of 69 patients receiving only standard bupivacaine. The liposomal bupivacaine group consumed 18% less narcotics during their hospitalization without significant differences in outcomes or complications. This may represent a reasonable treatment strategy to combat the “opioid epidemic”.

Hypothesis

Liposomal bupivacaine may reduce post-op narcotic use and length of stay in spinal deformity patients.

Design

Prospective, single-surgeon comparative cohort study

Introduction

Increasing public awareness of the dangers of narcotics use has prompted recent government legislation aimed at curtailing the “opioid crisis”. These new regulations place greater restrictions on physicians with some laws penalizing surgeons for excessive utilization of narcotics. Liposomal bupivacaine offers a potential alternative to heavy narcotics use post-operatively, but has demonstrated limited benefit in the literature to date.

Methods

159 adults undergoing elective spinal fusion (mean age 54.2) for scoliosis or kyphosis by a single surgeon (MSC) received either peri-incisional combined liposomal and standard bupivacaine (n = 90, group L) or standard bupivacaine only (n = 69, group C). There were no significant baseline demographic differences between the two groups. Post-op pain scores (VAS), opioid use, length of stay, functional outcome and peri-operative complications were recorded. IV and oral narcotic consumption from all sources were standardized to morphine-equivalent units (MEU). This study was independent of industry.

Results

Patients receiving liposomal bupivacaine consumed 18.0% less MEUs compared with controls (259 vs 316 mg) over their hospitalization. The liposomal group also weaned off IV narcotics significantly faster, with 52.6% less IV use by post-op day 3 compared with controls (12.0 vs 25.4 mg, P=0.03). This reduction in narcotic use did not significantly impact length of stay (L: 4.7 vs C: 4.8), as our protocol requirement of bowel movements before discharge ended up being the limiting factor. There were also no significant differences in post-op complication rates for ileus (L: 7[7.8%] vs C: 3[4.3%]) and superficial wound infection (L:1[1.1%] vs C: 0) as well as overall. Functional outcome scores were also no different by 6 weeks post-op.

Conclusion

Liposomal bupivacaine substantially reduces opioid requirements after adult spinal deformity surgery with no noticeable complications. However, the reduction in opioid use did not translate into quicker return of bowel function.