Efficacy of liposomal bupivacaine in spine surgery indicated but high quality evidence needed

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Liposomal bupivacaine (LB) may safely decrease postoperative opioid requirements, pain scores, and length of stay in patients undergoing spine surgery, but greater evidence is needed to assess its true efficacy, new research has shown.  

However, although she systematic review, published by Tommy Nguyen (Virginia Spine Institute, Reston, USA) et al in The Spine Journal, found that only low-quality evidence suggests that LB may safely decrease postoperative opioid requirements, pain scores, and length of stay in patients undergoing spine surgery, whereas moderate-quality evidence does not “support its use at this time”, according to the study authors.

As a result, “additional standardised, well-powered, prospective studies are necessary to more clearly assess the efficacy of LB in spine surgery,” Nguyen et al conclude.

The research was ultimately designed to consolidate and analyse the findings of retrospective cohort-matched studies and prospective randomised controlled trials investigating the use of LB in spine surgery.

MEDLINE, Cochrane controlled trials register, and Google Scholar were searched to identify all studies that examined the effect of LB use on outcomes in spine surgery. A total of 10 articles were identified that independently evaluated the effect of LB on reduction of postoperative opioid use, pain scores, hospital length of stay, cost, and incidence of adverse effects. The principles of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) were applied to assess the quality of evidence from each study.

There were 1,112 patients included in the ten studies. LB was found to be associated with significantly lower millimolar morphine equivalents of postoperative opioids, especially in opiate-tolerant patients, visual analogue scale scores, area under the curve of cumulative pain scores, numeric pain scale scores, and hospital length of stay, with comparable or lower odds of adverse effects relative to controls.


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