Liposomal bupivacaine incisional injection in single-level lumbar spine surgery

Abstract Background context Post-surgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine providing prolonged local anesthesia, up to 72 hours post-injection. While LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiskectomy has hitherto not been reported. If administration of LB as a pre-emptive analgesic agent at the end of microdiskectomy resulted in reduced postoperative pain, then this could minimize adverse events related to narcotic pain medication use and improve acute clinical outcomes. . Purpose To determine the comparative efficacy of infiltration of a standard dose and volume of liposomal bupivacaine in a comparative cohort analysis of single-level microdiskectomy procedures. Design Mixed Prospective/Retrospective Observational Cohort Analysis. Patient sample Adult patients presenting with lumbar or sacral compressive disc disease treated with single-level micro-disckectomy, at one instuition utilizing a standard surgical technique. No funding was received for this study. The authors have no disclosures. Outcome measures Time spent on intravenous (IV) narcotics post-operatively (primary outcome), post-operative visual analogue score (VAS), total morphine equivalent dose of narcotic pain medications and 30-day emergency room visits for pain control. Methods Under an approved process improvement project, immediate outcome and process measures for a prospective cohort of 40 patients who received LB field blocks following single-level lumbar microdiskectomy were compared to a historical cohort of 40 patients who underwent the same surgical procedure but did not receive post-surgical infiltration of local anesthetic. All patients received a standard open surgical technique and post-operative convalescence protocol, which included overnight admission, oral narcotic pain medication as needed, scheduled IV ketoralac and IV narcotic pain medication for breakthrough. Results Data from eighty subjects (67 males) operated on between January 2014 and 2015 were compared, including 40 cases, which occurred prior to using LB, and 40 cases after. There was no significant difference between mean age or BMI between groups