Literature Review
Efficacy of Liposomal Bupivacaine in Pediatric Patients Undergoing Spine Surgery
Cloyd C, Moffett BS, Brooke Bernhardt M, et al. Pediatric Anesthesia 2018;28(11):982-6
Pain management after extensive spine surgery in children is challenging. Multimodal analgesia, including local anesthetics, has been advocated to decrease opioid use. Due to short duration of action local anesthetics are limited in their effect unless administered with a continuous catheter technique, which introduces new risks. This study aims to examine whether the prolonged analgesia described with liposomal bupivacaine will have an effect on 72h-postoperative opioid and other analgesic use.
Methods
A retrospective cohort study in 141 patients (85% female, median age 14 years) undergoing posterior spinal surgery (single surgeon) compared those who received liposomal bupivacaine (47) with 1:2 age, gender, and extend of surgery-matched controls (94) who had bupivacaine. Assessment tools included descriptive methods to characterize the patient population and surgery, Numeric Pain Rating Scale to assess pain, and queries of the electronic medical record to assess 72 h=postoperative opioid, acetaminophen and ketorolac use.
Results
Patients who received liposomal bupivacaine did not required less acetaminophen, ketorolac, or opioids in the postoperative period. Pain in both groups was well controlled without a significant difference. The medium length of stay was the same.
Conclusion
Liposomal bupivacaine administered at the end of surgery before skin closure did not have an effect of 72h-postoperative analgesic needs in pediatric patients undergoing posterior spinal surgery. Further studies may need to address whether liposomal bupivacaine is of any benefit in the complex tissue trauma associated with orthopedic spine surgeries. Limitations of the study include retrospective nature, overall low pain scores, and non-standardized liposomal bupivacaine dosing and overall pain management.
