63. Liposomal bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing ACDF

Abstract

BACKGROUND CONTEXT Liposomal bupivacaine (LB) is local anesthetic perioperatively infiltrated into the surgical site to promote postoperative analgesia. Despite its widespread use, definitive data demonstrating its efficacy is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). PURPOSE To examine whether ACDF patients who received preoperative LB (LB group) exhibited decreased postoperative opioid use and length of hospital stay (LOS) compared to ACDF patients who did not receive preoperative LB (controls). STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE Eighty-two patients who underwent primary ACDF (n\u202f=\u202f82). OUTCOME MEASURES Surgical complications, postoperative opioid use, and LOS. METHODS Eighty-two patients who underwent primary ACDF by a single surgeon from 2016-2019 were retrospectively identified from an institutional database. Patient demographics, medical comorbidities, surgical complications, postoperative opioid use and LOS were collected. Data were analyzed using independent t-tests, chi-square tests and multiple linear regression. RESULTS Fifty-nine patients received preoperative LB (LB group) while 23 patients did not (controls). Univariate analysis revealed that the LB group did not require significantly fewer opioids on postoperative day (POD) 0 (p\u202f=\u202f0.471), POD1 (p\u202f=\u202f0.970), POD2 (p\u202f=\u202f0.914), throughout the entire hospital course (p\u202f=\u202f0.845), or throughout the entire hospital course after normalizing by LOS (p\u202f=\u202f0.538). There was also no significant difference in LOS between groups (p =0.833). Multivariate analysis showed that the number of cervical vertebrae involved in the operation significantly predicted opioid use on POD0 (p\u202f=\u202f0.005) and throughout the hospital course after normalizing by LOS (p\u202f=\u202f0.024) but LB use, age, and body mass index (BMI) did not. For every additional vertebral level involved, approximately 225 additional morphine milligram equivalents (MMEs) were utilized on POD0 while 156 additional MMEs were utilized throughout the hospital course after normalizing by LOS. CONCLUSIONS ACDF patients who received preoperative LB did not require fewer postoperative opioids or exhibit a decreased LOS compared to controls. Patients whose procedures involved a greater number of cervical vertebrae were associated with greater opioid use on POD0 and throughout the hospital course after normalizing by LOS. The results of this study suggest that ACDF patients, especially those with a high number of vertebrae involved, may require additional or alternative analgesia to LB. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.