Evaluation of Liposomal Bupivacaine Use in Elective Cerebral Aneurysm Surgery

Liposomal bupivacaine (LB) is a long-lasting formulation of local anesthetic which can be effective up to 72 hours postoperatively. Although it is approved for postsurgical analgesia through local wound infiltration and has frequently been used in spine surgery, there is little evidence regarding the effect of LB on cranial surgery postoperative care.

We retrospectively reviewed 79 patients who underwent elective craniotomy for unruptured anterior circulation aneurysms, of which 44 were given LB and 35 were not. Postoperative pain scores, length of stay (LOS), opioid use, and cost of pain medication were all obtained from the patients' charts and analyzed.

There was no significant difference in initial pain scores, average pain scores, opioid use, or intensive care unit or overall LOS. However, the total cost of pain medication when taking into account the cost of LB was significantly higher in the LB group compared with the control group ($647.84 ± 122.50 compared with $284.77 ± 113.44; P < .0001).

Our data illustrate that LB does not seem to affect average pain score, total opioid use, opioid cost, or LOS but does seem to be associated with an overall increase in total cost of pain medication owing to the significant cost of LB. We suspect that although pain control is important in cranial surgery, the effect of LB is not substantial enough to affect overall pain control in these patients and is not a primary driver of hospitalization. However, further prospective, randomized studies would be helpful to evaluate the overall benefit of LB on cranial surgery outcomes.