Introduction: Post-operative pain following transforaminal lumbar interbody fusion (TLIF)is difficult to treat. The purpose of this retrospective study was to investigate post-operative pain control, analgesic consumption, and length of stay in TLIF patients receiving intraoperative liposomal bupivacaine.
Methods: Seventy-four patients underwent unilateral, single level TLIFs. Half of these patients received standard of care post-operative analgesics, while the other half received an intraoperative injection of liposomal bupivacaine via local infiltration in addition to the standard of care post-operative analgesic regimen. Post-operative pain scores, analgesic consumption, length of stay, and post-operative complications were then compared between groups.
Results: Post-operative pain was assessed using a visual analog scale (VAS). Cumulative pain over twelve hour intervals was calculated using the area under the curve (AUC) method. AUC was significantly lower for the liposomal bupivacaine group between 0-12 hours (15.0 ± 6.4 versus 45.2 ± 3.6, p=0.0029) and 12-24 hours (37.6 ± 3.4 versus 48.4 ± 4.2, p=0.0499) after surgery. Both groups had minimal narcotic consumption between 0-12 hours post-operatively, while the liposomal bupivacaine group required significantly less narcotic equivalents than the control group between 12-24 hours (16.0 ± 2.2 mg versus 24.1 ± 3.2 mg IV morphine equivalents, p=0.0425). Length of stay for the liposomal bupivacaine group was significantly shorter than for the standard of care group by 1.2 days (decreased from 4.3 ± 0.2 days to 3.1 ± 0.1 days, p < 0.0001). The complication rate was 8.1% in both groups.
Conclusions: Liposomal bupivacaine may be a useful adjunct during unilateral TLIF for decreasing pain and narcotic consumption in the first 24 hours and decreasing length of stay. However, prospective evaluation is necessary to corroborate these findings.
Patient Care: Today's techniques allow TLIF surgery to be done in a less invasive fashion. Despite improved techniques, post-operative pain is still often debilitating and difficult to treat. This research shows that liposomal bupivacaine may be helpful in treating this post-operative pain, which I believe improves patient care and might improve a patient's post-operative course. These results support further study of liposomal bupivacaine injection in spinal operations.
Learning Objectives: By the conclusion of this presentation, participants should understand that:
1)Liposomal bupivacaine injection during unilateral TLIF surgery resulted in pain reduction and decreased narcotic consumption in the first 24 hours after surgery.
2)Length of stay was over one day shorter in the liposomal bupivacaine group compared to the control group.
3)While this study shows promise for the use of liposomal bupivacaine injection during TLIF surgery, the study is retrospective. Prospective studies are necessary to corroborate these findings.