The role of liposomal bupivacaine in reduction of post-operative pain after Transforaminal Lumbar Interbody Fusion (TLIF): A clinical study

• Published in: World neurosurgery 2015
• Main Authors: Kim, Jackson, BS, Burke, Shane M., BS, Kryzanski, James T., MD, Roberts, Russel J., PharmD, Roguski, Marie, MD, MPH, Qu, Evan, Hwang, Steven W., MD, Liu, Penny P., MD, Desilier, Adriana, MD, Riesenburger, Ron I., MD
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.04.058

Abstract Background Post-operative pain following transforaminal lumbar interbody fusion (TLIF) is a barrier to early mobility. Intraoperative local infiltration of anesthetic agents is standard practice to alleviate post-operative 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 post-operative pain control in patients undergoing unilateral, single level TLIF. Methods From a cohort of 74 patients, half received non-liposomal local anesthetic (Group C) and half received liposomal bupivacaine (Group LB) via local infiltration. Both groups received a standard post-operative analgesia regimen. Demographic information, post-operative pain scores (visual analog scale), analgesic consumption, length of stay, and complications were retrospectively collected. Results The area under the curve (AUC) of cumulative pain scores was significantly lower in the LB group between 0 and 12 hours (15.0 ± 15.6 versus 45.6 ± 21.1, p=.003) and between 12 and 24 hours (37.6 ± 20.6 versus 48.4 ± 24.9, p=.05) after surgery. Significantly fewer narcotic equivalents were consumed in the LB group between 12 and 24 hours (16.0 ± 13.4 mg versus 24.1 ± 19.7 mg IV morphine equivalents, p=.04. Length of stay was significantly shorter in the LB group than in the control group (3.1 ± 0.9 days versus 4.3 ± 1.3 days, p < .001). Conclusions Liposomal bupivacaine 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.