Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 71. Liposomal bupivacaine reduces narcotic consumption in adult deformity surgery

Abstract

BACKGROUND CONTEXT Increasing public awareness of the dangers of narcotics use has prompted recent government legislation aimed at curtailing the 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 postoperatively, but has demonstrated limited benefit in the literature to date. PURPOSE To determine if liposomal bupivacaine reduces postop narcotic use and length of stay in spinal deformity patients. STUDY DESIGN/SETTING Prospective, single-surgeon comparative cohort study. PATIENT SAMPLE Adults undergoing arthrodesis of seven or more levels for spinal deformity. OUTCOME MEASURES Visual Analog Scale (VAS), narcotic utilization, length of stay, perioperative complication rates. METHODS A total of 159 consecutive adults undergoing elective spinal fusion (mean age 54.2) for scoliosis or kyphosis by a single surgeon (MSC) received either peri-incisional injections of 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. Postop pain scores (VAS), opioid use, length of stay, functional outcome and perioperative complications were recorded. IV and oral narcotic consumption from all sources were standardized to morphine-equivalent units. This study was performed completely independent of industry. RESULTS 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=.03). However, this reduction in narcotic use did not significantly impact length of stay (L: 4.7 vs. C: 4.8), as our protocol requirement of return of bowel movements before discharge ended up being the limiting factor. There were also no significant differences in postop 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 postop. 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. FDA DEVICE/DRUG STATUS Liposomal Bupivacaine (Approved for this indication)