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Liposomal Bupivacaine Is Both Safe and Effective in Controlling Postoperative Pain After Spinal Surgery in Children:
Morad Chughtai1, Assem A Sultan1, Brittany Hudson1
1Departments of Orthopaedic Surgery.
Insights
Liposomal bupivacaine (LB) significantly reduced pain and opioid use in pediatric spinal surgery patients. This long-acting anesthetic also shortened hospital stays with comparable safety to standard care.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Pediatric Care
Background:
- Liposomal bupivacaine (LB) is a long-acting local anesthetic previously studied in adults.
- Its efficacy and safety in pediatric spinal deformity correction remain unevaluated.
Purpose of the Study:
- To assess LB's effectiveness in pain relief after pediatric spinal surgery.
- To compare opioid consumption, length of stay, discharge disposition, and safety between LB and standard pain management.
Main Methods:
- Retrospective comparative cohort study of 195 patients receiving LB and 128 patients receiving standard care.
- Data collected on pain intensity, opioid consumption, length of stay, and discharge disposition.
- Statistical analysis included noninferiority tests and multivariate models.
Main Results:
- LB group showed significantly lower pain scores and opioid consumption (P<0.001).
- Patients receiving LB had shorter hospital stays (P<0.001) and similar discharge to home rates (98% vs 97%).
- Complication rates were similar, with LB showing lower odds for complications (OR=0.77, P=0.009).
Conclusions:
- Liposomal bupivacaine is safe and effective for pediatric spinal surgery pain management.
- LB enhances multimodal pain regimens, reducing pain, opioid use, and length of stay.
Study Design:
Retrospective comparative cohort study.
Objective:
To evaluate: (1) pain relief efficacy; (2) opioid consumption; (3) length of stay (LOS); (4) discharge disposition (DD); and (5) safety and adverse effects of liposomal bupivacaine (LB) in pediatric patients who underwent spinal deformity correction.
Summary Of Background Data:
LB is a long-acting, locally injectable anesthetic. Previous orthopedic studies investigating its use have been limited to adult patients. The use of LB as part of postoperative pain management in pediatric patients undergoing spine deformity correction surgery is yet to be evaluated.
Materials And Methods:
A total of 195 patients that received LB as part of their postoperative pain management regimen were compared with 128 patients who received standard pain management without LB. Pain intensity, opioid consumption, LOS, and DD were recorded. Potential LB-related complications were reported as frequencies and statistically compared for superiority. Noninferiority tests were performed using the Farrington-Manning score test. Multivariate tests based on generalized estimating equations were performed to determine the common and average treatment effects. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.
Results:
The LB cohort demonstrated lower pain scores [postoperative day 1 (POD 1)-median=2, interquartile range (IQR)=(0-5) vs. 5 (2.5-7); POD 2-3 (0-5) vs. 4 (3-6); P<0.001], lower overall opioid consumption (78.2 vs. 129 morphine milligram equivalents; P=0.0001) and consistently from POD 0 to 3 (mean differences; 7.47, 9.04, 17.2, and 17.3 morphine milligram equivalents, respectively; P<0.01), shorter LOS (median=3 d, IQR=3-4 vs. 4 d, IQR=4-6; P<0.001), and similar to-home DD (98% vs. 97%). Complications were similar among the cohorts in superiority and 10% noninferiority analyses. Patients in the LB cohort had lower odds for complications (odds ratio=0.77; 95% CI, 0.64-0.93; P=0.009 and 0.67; 95% CI, 0.50-0.90; P=0.008).
Conclusions:
This study demonstrated the safety and efficacy of LB when added to the current multimodal postoperative pain management regimens after pediatric spinal surgery.
Level Of Evidence:
Level III.
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