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Intrawound Liposomal Bupivacaine in Pediatric Chiari Decompression: A Retrospective Study
Melissa A LoPresti1,2, B Nathan Harrell2, Eric Goethe1,2
1Department of Neurosurgery, Baylor College of Medicine, Houston, Tex.
Insights
Intrawound liposomal bupivacaine may reduce opioid use in pediatric Chiari decompression patients. This study suggests it offers adequate pain control while decreasing inpatient and outpatient opioid consumption.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pediatric Surgery
Background:
- Intrawound liposomal bupivacaine is a long-acting local anesthetic for postoperative pain management.
- Its use is established in adults for posterior cervical and suboccipital approaches but is off-label in pediatrics.
Purpose of the Study:
- To examine the efficacy of intrawound liposomal bupivacaine in pediatric Chiari decompression.
- To evaluate its impact on postoperative opioid consumption in pediatric patients.
Main Methods:
- Retrospective analysis of pediatric patients (0-18 years) undergoing Chiari decompression (Jan 2017-July 2019).
- Data collected included demographics, postoperative opioid use, pain control (subjective and objective), length of stay, and discharge medications.
- Comparison between patients who received intrawound liposomal bupivacaine and those who did not.
Main Results:
- Six out of 30 pediatric patients received intrawound liposomal bupivacaine.
- Patients treated with liposomal bupivacaine required fewer inpatient opioids.
- No significant difference in immediate postoperative pain, follow-up pain control, or length of stay was observed.
- Patients receiving liposomal bupivacaine did not require opioid analgesics at hospital discharge.
Conclusions:
- Intrawound liposomal bupivacaine shows potential for decreasing inpatient and outpatient opioid consumption in pediatric Chiari decompression.
- It appears to provide adequate pain control, supporting its role in opioid-sparing strategies for pediatric surgical patients.
- Further prospective studies and clinical trials are recommended to confirm efficacy.
Abstract:
Intrawound liposomal bupivacaine is a long-acting local anesthetic used to decrease postoperative pain in various procedures. Although it is used in posterior cervical and suboccipital approaches in the adult population, it is currently off-label for pediatrics. This quality improvement (QI) project examines intrawound liposomal bupivacaine for pediatric Chiari decompression and evaluates its role in postoperative opioid consumption.
Methods:
We retrospectively analyzed all patients 0-18 years old of age who underwent Chiari decompression from January 2017 to July 2019 at our tertiary care hospital. Demographic and clinical data regarding postoperative opioid use, subjective and objective pain control, length of stay, discharge medications, and comorbid conditions were collected.
Results:
We included 30 patients in this study: 19 females and 11 males. Of these, 6 received an intrawound injection of liposomal bupivacaine.
Patients:
treated with liposomal bupivacaine require fewer opioids while admitted. There was no apparent difference in pain control immediately postoperatively, pain control at clinical follow-up, or inpatient length of stay between each group. Patients who received liposomal bupivacaine did not require opioid analgesics at the time of discharge from the hospital.
Conclusion:
The use of intrawound liposomal bupivacaine may decrease inpatient and outpatient postoperative opioid consumption amongst pediatric patients following Chiari decompression while providing adequate pain control. We investigate liposomal bupivacaine perioperative blockade in this QI project as a viable option for opioid-sparing pain control in the postoperative setting for the pediatric population. Future investigation via clinical trials and more extensive prospective studies may glean further insights into efficacy.
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