Does liposomal bupivacaine reduce hospital length of stay for multilevel lumbar decompressions? A retrospective matched cohort study

Abstract

Objectives: Adequate post-operative pain control improves patient outcomes, leading to fewer analgesia-related complications and shorter length of hospital stay (LOS). Liposomal bupivacaine (LB) is a long-acting injectable anesthetic. This study evaluates the impact of local LB use on pain control outcomes (LOS, visual analog scale [VAS], narcotic usage, readmission, and complications) after multilevel spinal decompression surgery compared to matched cohorts without local LB. Methods: A single-center retrospective cohort study matched by age, gender, body mass index (BMI), medical comorbidities, and previous use of opioids was done at our institute. Subjects were divided into two groups; one who had LB at the end of spine surgery and one without LB. Patients’ demographics, number of operating levels, and outcomes parameters (LOS and VAS), number of pain medications used preoperatively, through the hospitalization and at discharge, complication rate, and readmission rate were collected. Results: Eighty-six patients with spinal stenosis were included; 45 (52.3%) in the LB group and 41 (47.7%) in the non-LB group. The average age was 67.8 ± 10.5. Both groups were comparable in terms of BMI and medical comorbidities. There was no diffidence in pain killers consumption between the two groups, throughout hospitalization and at the discharge. Strong statistically significant difference with VAS score favoring LB use (P < 0.001). LOS was 15 h less in the LB group (32.4 ± 36.6 vs. 47.5 ± 39.1) (P = 0.069). The complication rate was 10.6%, with no difference between both groups (P = 0.49). Both groups had no readmissions or the emergency department visits for pain complaints. After excluding patients with complications, LOS was significantly shorter in the LB group (P = 0.029). In subgroup analysis for the LB group to look for the impact of the learning curve, the VAS score was less, and LOS was shorter in the second half of the included patients. However, the difference did not reach statistical significance. Conclusion: LB, as local infiltration at the end of a multilevel lumbar decompression, is an effective tool to decrease post-operative pain and shorten hospital stay, especially in patient with no post-operative complications.