The Effect of Liposomal Bupivacaine (Exparel) on Postoperative Narcotic Consumption Following Lumbar Spinal Fusion

The 63rd Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 28, 2025; 3-6 p.m.; D1.700 Lecture Hall) ; BACKGROUND: Lumbar spine surgery via posterior approaches can involve significant trauma of native structures that often results in intense postoperative pain. Despite advances in less invasive surgical technique and acute pain management, reliance on opioid medications remains a major issue following these spinal procedures. While the analgesic effects of opioid medications can be effective, the large side-effect profile, delayed recovery times, and risk of addiction/overdose associated with narcotic use demonstrates the clear need for alternative pain management strategies. This study assessed the efficacy of intraoperative liposomal bupivacaine infiltration in reducing postoperative opioid consumption and admission/PACU times. METHODS: A retrospective chart review of 96 patients who underwent lumbar laminectomy and fusion treated by two surgeons in a single institution was conducted. Inclusion criteria for the analysis was limited to either transforaminal lumbar interbody fusion or posterolateral arthrodesis for single-level or multi-level lumbar fusions. 48 patients who received intraoperative liposomal bupivacaine were compared with 48 control patients who were operated on prior to the initial hospital use of liposomal bupivacaine. Total postoperative narcotic consumption was measured and converted to morphine milligram equivalents (MME). Hospital length of stay (LOS) and total time spent in the PACU were also recorded. RESULTS: The liposomal bupivacaine cohort demonstrated significantly lower IV opioid consumption during their admission compared with the control group (p = 0.0142). Oral opioid consumption, LOS, and PACU time were not statistically lower compared to the control cohort; however, there was a trend toward decreased oral narcotic use and PACU/admission times in the liposomal bupivacaine group. These findings suggest that liposomal bupivacaine injections ...