The Role of Liposomal Bupivacaine in Reduction of Postoperative Pain After Transforaminal Lumbar Interbody Fusion: A Clinical Study.
BACKGROUND
Postoperative pain after transforaminal lumbar interbody fusion (TLIF) is a barrier to early mobility. Intraoperative local infiltration of anesthetic agents is standard practice to alleviate postoperative pain. Liposomal formulations may prolong the action of these anesthetic agents. The purpose of this study was to investigate the role of liposomal bupivacaine in postoperative pain control in patients undergoing unilateral, single-level TLIF.


METHODS
From a cohort of 74 patients, half received nonliposomal local anesthetic and half received liposomal bupivacaine (LB) (LB group) via local infiltration. Both groups received a standard postoperative analgesia regimen. Demographic information, postoperative pain scores (visual analog scale), analgesic consumption, length of stay, and complications were retrospectively collected.


RESULTS
The area under the curve of cumulative pain scores was significantly lower in the LB group between 0 and 12 hours (15.0 ± 15.6 vs. 45.6 ± 21.1, P = 0.003) and between 12 and 24 hours (37.6 ± 20.6 vs. 48.4 ± 24.9, P = 0.05) after surgery. Significantly fewer narcotic equivalents were consumed in the LB group between 12 and 24 hours (16.0 ± 13.4 mg vs. 24.1 ± 19.7 mg intravenous morphine equivalents, P = 0.04). Length of stay was significantly shorter in the LB group than in the control group (3.1 ± 0.9 days vs. 4.3 ± 1.3 days, P < .001).


CONCLUSIONS
LB may be a useful adjunct during unilateral TLIF for decreasing pain and narcotic consumption in the first 24 hours after surgery and may also decrease overall length of stay.
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Jackson
J
Kim
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Shane M
SM
Burke
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
James T
JT
Kryzanski
Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA.
Russel J
RJ
Roberts
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Marie
M
Roguski
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Evan
E
Qu
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Steven W
SW
Hwang
Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts, USA; Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts, USA.
Penny P
PP
Liu
Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts, USA; Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts, USA.
Adriana
A
Desilier
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA. Electronic address: rriesenburger@tuftsmedicalcenter.org.
Ron I
RI
Riesenburger
D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019540:Area Under Curve; D016063:Blood Loss, Surgical; D002045:Bupivacaine / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine
Length of stay; Liposomal bupivacaine; Postoperative narcotic requirement; Postoperative pain; Spine surgery; Transforaminal lumbar interbody fusion