The Use of Perioperative Liposomal Bupivacaine during Spine Surgeries Does Not Produce Improved Postoperative Pain Control in Adults: A Systematic Review

Abstract

Recovery following spinal surgery can be challenging, particularly concerning postoperative pain management. The first‐line treatment for postoperative pain is opioid analgesia, but opioid overuse can lead to adverse effects. Liposomal bupivacaine (LB), an extended‐release local anesthetic, has shown promise as a method of enhancing postoperative pain control. This systematic review aims to provide a comprehensive evaluation of the effectiveness of LB in improving postoperative outcomes after spinal surgery. Following the PRISMA guidelines, 18 studies met inclusion criteria and were evaluated for pain, opioid consumption, length of stay (LOS), and adverse events. Six studies showed no significant difference between treatment groups in all three major outcomes. Only two studies showed statistically improved pain control, opioid use, and LOS with LB. Similarly, another study also demonstrated improved pain control in the LB group; however, there was no significant change in opioid use or LOS. Two other studies also showed significantly improved postoperative pain control after the administration of LB, but the effect lasted only 24 hours after surgery. Three other reports saw a quicker transition off intravenous opioids with LB use, but no difference in total opioid use. Three of the four studies that focused on pediatric populations found improvement in all major outcomes with LB use; the fourth saw no significant difference between treatment groups. Currently, evidence is poor to suggest that LB significantly improves postoperative pain, opioid use, or LOS in adults. However, several patterns were identified that may influence study results: reports performed at military bases have different, more stringent protocols for recovery, and differences in spinal surgeries, some more invasive than others, can lead to different pain levels. The results of this systematic review demonstrate that the addition of LB does not provide improved postoperative pain control after spinal surgery in adults as demonstrated by both randomized controlled trials (RCTs) and the majority of retrospective cohort studies (RCSs). However, the use of LB for spine surgeries may be justified for the pediatric population, but further research is warranted given the limited reports available.