P131. Liposomal Bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior and posterior lumbar discectomy and fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> Patients undergoing lumbar spinal surgery often report significant postoperative pain, necessitating increased postoperative analgesia and prolonging hospital stay. Liposomal bupivacaine (LB) is a novel local anesthetic encapsulated in a lipid bilayer, resulting in sustained-release analgesia, that is believed to decrease postoperative pain. While the efficacy of perioperative LB infiltration has been demonstrated in various orthopedic procedures, there has been little evidence for its use in patients undergoing lumbar spinal surgery. <h3>PURPOSE</h3> The aim of this paper was to evaluate the efficacy of liposomal bupivacaine for lowering postoperative opiate usage and length of hospital stay in the management of anterior and posterior lumbar decompression and fusion. <h3>STUDY DESIGN/SETTING</h3> A retrospective study consisting of 107 patients who underwent lumbar spinal surgery performed by a single surgeon (R.V.) from 2016 to 2019. <h3>PATIENT SAMPLE</h3> A total of 107 patients included in analysis were those who underwent anterior or posterior decompression and fusion for lumbar spondylolisthesis and stenosis. <h3>OUTCOME MEASURES</h3> Postoperative opiate use in morphine equivalents (mEq) and hospital length of stay (LOS). <h3>METHODS</h3> Demographic information, postoperative opiate use and length of hospital stay were obtained through in-depth review of electronic medical records (EMR). Data were analyzed using independent t-tests and multiple linear regression. <h3>RESULTS</h3> There were 51 (47.6%) patients who received LB, while 56 patients did not receive any perioperative local anesthetic. Patients who received LB did not have significantly lower postoperative opiate usage on postoperative day (POD) 0, POD1, POD2, or total per LOS (p=0.861, 0.602, 0.721, 0.974 respectively). Multivariate analysis showed age significantly predicted postoperative opiate usage on POD 0 (p=0.044) and total per LOS (p=0.035), while LB did not. Patients that received LB had a longer LOS with a mean of 5.45 days compared to 4.7 days for patients that did not receive LB, although significance was not reached (p=0.235). <h3>CONCLUSIONS</h3> Local anesthetics are often employed by surgeons to improve postoperative pain control. LB did not significantly decrease postoperative opiate use or shorten LOS. At this time LB was not shown to be clinically effective in patients undergoing anterior or posterior discectomy and fusion, though further evaluation is required. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.