Liposomal Bupivacaine Reduces Narcotic Consumption in Adult Spinal Deformity Surgery

2018

Background Context

Increasing public awareness of the dangers of narcotics use has prompted recent government legislation aimed at curtailing the "opioid crisis". Many of these new regulations are placing greater restrictions on the ability of physicians to prescribe narcotics with some laws penalizing surgeons for excessive utilization. Liposomal bupivacaine offers a potential alternative to heavy narcotics use post-operatively, but has demonstrated limited benefit in the literature to date. Data regarding its effect on post-operative pain in the setting of adult spinal deformity correction is limited. 

Purpose

This study sought to determine if local administration of liposomal bupivacaine reduces post-op narcotic use and length of stay in spinal deformity patients.

Design

Prospective cohort study

Patient Sample

Utilizing a single-surgeon’s practice database, we identified 159 patients undergoing adult spinal deformity correction.

 Outcome Measures

Peri-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.

Methods

A prospective cohort study was conducted of adult patients undergoing elective spinal fusion (7 or more levels) for scoliosis or kyphosis by a single surgeon.  Patients received either peri-incisional injections of combined liposomal and standard bupivacaine (n = 90, group L) or standard bupivacaine only (n = 69, group C). There was no external source of funding. This study was performed independent of industry.

Results

159 patients met inclusion criteria (mean age was 54.2 years of age). There were no significant baseline demographic differences between the two groups. Patients receiving liposomal bupivacaine consumed 18.0% less morphine-equivalent units compared with the control group (259 vs 316 mg) over their hospitalization. The liposomal group also transitioned off IV narcotics significantly faster, with 52.6% less IV use by postop day 3 compared with the control arm (12.0 vs 25.4 mg, P=0.03). However, this reduction in narcotic use did not significantly impact length of stay (L: 4.7 vs C: 4.8). There were also no significant differences in post-op complication rates overall as well as specifically ileus (L: 7[7.8%] vs C: 3[4.3%]) and superficial wound infection (L:1[1.1%] vs C: 0). Functional outcome scores were also no different by 6 weeks post-op.

Conclusions

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.