ISSN 2380-2995 (Online)
ISSN 2380-2987 (Print)


Ronald W. Lindsey, MD
Zbigniew Gugala, MD, PhD


Efficacy of Liposomal Bupivacaine for Postoperative Pain after Spine Surgery

Jonathan D. Hughes, MD; Christopher D. Chaput, MD; Yolanda Munoz Maldonado, PhD; Mark Rahm, MD

Department Orthopaedic Surgery, Baylor Scott and White Health; Temple, TX, USA

Corresponding Author:
Jonathan D. Hughes, MD
Orthopaedic Surgery
Baylor Scott & White Health
2401 South 31st Street
Temple, TX 76508, USA



Introduction: Pain control following spine surgery can be challenging. Recently, there has been increasing interest in the use of multimodal pain regimens, including local perioperative analgesia, over postoperative narcotic use.

Methods: Twenty-four patients undergoing spine surgery from August 2013 to September 2014 received liposomal bupivacaine (LB) intraoperatively. The type of surgery, age, and BMI were used to match the experimental group with twenty-four control patients between July 2012 and August 2013. The length of hospital stay, postoperative pain scores and postoperative opioid requirements were compared between the two groups.

Results: The median length of hospital stay was 1 day in the LB group and 2 days in the control group. The VAS score was 3.3 and 5.7 at 0-6 hours, 3.3 and 6.2 at 6-24 hours, and 3.4 and 6.0 at 24-48 hours, for the LB and control group, respectively. The distributions of the mean VAS scores were significantly different at 0-6 hrs, 6-24 hours, and 24-48 hours, with smaller average VAS scores in the LB group. Median morphine equivalent use was 10.0 mg and 22.3 mg at 0-6 hours, 6.7 mg and 14.0 mg at 6-12 hours, 15.0 mg and 27.0 mg at 12-24 hours, and 31.3 mg and 30.0 mg at 24-48 hours, for the LB and control group, respectively.

Discussion: We found a decrease in LOS, total narcotic usage, and patient-reported pain scores up to 48 hours postoperatively with the use of LB. These results suggest that LB can play a valuable role in decreasing LOS while improving pain control after routine spine surgery.

Level of Evidence: III; Case-control study.

Keywords: Liposomal bupivacaine; Spine surgery; Postoperative pain; Outcomes; Opioids.