Liposomal bupivacaine reduces postoperative pain and opioids consumption in spine surgery: a meta-analysis of 1,269 patients

BACKGROUND CONTEXT: Postoperative pain management in spine surgery remains a challenge. Liposomal bupivacaine (LB) has emerged as an alternative or adjunct to opioid-based analgesia. However, existing studies evaluating LB efficacy in spine surgery yield conflicting results and a meta-analysis compiling the literature is lacking. PURPOSE: The purpose of this meta-analysis was to evaluate pain outcomes, opioid use, and LOS following LB administration after spine surgery. STUDY DESIGN: Meta-analysis. METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1 -20) were accessed and explored up to May 2024. Data on medical complications, postoperative pain, postoperative opioid consumption, and length of stay were extracted. Mean differences (MD) with 95% CI were used for continuous data, and odds ratios (OR) were calculated for dichotomous data. RESULTS: This meta-analysis comprised eleven studies consisting of 1,269 patients (677 in the LB group, 592 in the control group). No statistically significant difference was observed in complication rates. The LB group exhibited significantly lower pain scores at postoperative day 2 (MD=-0.31; 95% CI:-0.52 to-0.09, p=.006), lower postoperative opioid consumption (MD=-0.42; 95% CI:-0.79 to-0.06, p=.02), and shorter length of stay (MD=-0.57; 95% CI:-0.94 to-0.20, p=.002). CONCLUSION: In the immediate postoperative period after spine surgery, the utilization of liposomal bupivacaine was associated with improved pain outcomes, decreased opioid consumption, and shortened length of stay. Although further research is warranted, these findings suggest that LB may offer a valuable adjunct to pain management strategies in patients undergoing spine surgery. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.