Cloyd Colleen, Moffett Brady S, Bernhardt Melanie Brooke, Monico Evelyn M, Patel Nihar, Hanson Darrell
Texas Children's Hospital, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
Paediatr Anaesth. 2018 Nov;28(11):982-986. doi: 10.1111/pan.13482. Epub 2018 Sep 11.
Liposomal bupivacaine may be an option for reducing opioid utilization in pediatric scoliosis surgery. The use of liposomal bupivacaine in this patient population has not been previously described.
Patients who underwent posterior spinal fusion surgery at our institution from 2011-2016 were identified. We performed a retrospective matched cohort study, matching patients who received intraoperative liposomal bupivacaine by age, gender, and extent of surgery to patients who did not. The primary endpoint was the use of morphine equivalents in the first 72 hours after surgery. Data collection included demographic and surgical data, pain medication utilization, and pain scores. Area under the curve (AUC) for pain scores was calculated. Descriptive statistical methods and univariable analysis were used to compare patients who received liposomal bupivacaine to patients who did not.
One hundred and forty-one patients met study criteria; 47 patients who received liposomal bupivacaine were matched to 94 control patients who did not receive liposomal bupivacaine. No significant differences were noted in the patient population with the patients requiring a median of 11 segments (range 10-13 segments) fused. Patients received a mean of 56.6 ± 37.4 mg/kg of intravenous acetaminophen, a mean of 3.4 ± 2.1 mg/kg of intravenous ketorolac, and 1.9 ± 0.93 mg/kg of morphine equivalents in the first 72 hours after surgery. On univariable analysis, no differences were noted in intravenous acetaminophen use, pain score AUC, intravenous ketorolac use, or morphine equivalents (2.0 ± 98 vs 1.8 ± 0.82) in patients who did not receive liposomal bupivacaine as compared to those patient who did received liposomal bupivacaine.
Liposomal bupivacaine was not associated with reductions in postoperative opioid use in pediatric spinal surgery.
脂质体布比卡因可能是减少小儿脊柱侧弯手术中阿片类药物使用的一种选择。此前尚未描述过在该患者群体中使用脂质体布比卡因的情况。
确定2011年至2016年在我们机构接受后路脊柱融合手术的患者。我们进行了一项回顾性匹配队列研究，将术中接受脂质体布比卡因的患者按年龄、性别和手术范围与未接受的患者进行匹配。主要终点是术后72小时内吗啡等效物的使用情况。数据收集包括人口统计学和手术数据、止痛药物使用情况以及疼痛评分。计算疼痛评分的曲线下面积（AUC）。使用描述性统计方法和单变量分析来比较接受脂质体布比卡因的患者和未接受的患者。
141名患者符合研究标准；47名接受脂质体布比卡因的患者与94名未接受脂质体布比卡因的对照患者相匹配。在需要融合中位数为11节段（范围为10 - 13节段）的患者群体中未观察到显著差异。患者在术后72小时内平均接受了56.6±37.4mg/kg的静脉注射对乙酰氨基酚、平均3.4±2.1mg/kg的静脉注射酮咯酸以及1.9±0.93mg/kg的吗啡等效物。在单变量分析中，与接受脂质体布比卡因的患者相比，未接受脂质体布比卡因的患者在静脉注射对乙酰氨基酚的使用、疼痛评分AUC、静脉注射酮咯酸的使用或吗啡等效物（2.0±98对1.8±0.82）方面没有差异。
脂质体布比卡因与小儿脊柱手术中术后阿片类药物使用的减少无关。
