Neufeld Eric V, Ng Terence, Schaffler Benjamin C, Iturriaga Cesar, Katz Austen, Job Alan, Petersen Christopher, Perfetti Dean, Verma Rohit
Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center/North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
Department of Orthopaedic Surgery, New York University Langone Health, Grossman School of Medicine, New York, NY, USA.
J Spine Surg. 2022 Sep;8(3):314-322. doi: 10.21037/jss-22-34.
Despite its widespread use, definitive data demonstrating the efficacy of liposomal bupivacaine (LB) is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). Therefore, this investigation examined whether ACDF patients who received intra-operative LB (LB cohort) exhibited decreased post-operative opioid use and lengths of hospital stay (LOS) compared to ACDF patients who did not receive intra-operative LB (controls).
Eighty-two patients who underwent primary ACDF by a single surgeon from 2016 to 2019 were identified from an institutional database. Fifty-nine patients received intra-operative LB while twenty-three did not. Patient characteristics, medical comorbidities, complications, post-operative opioid consumption, and LOS data were collected.
The LB cohort did not require fewer opioids on post-operative day (POD) 0, POD1, POD2, or throughout the hospital course after normalizing by LOS (total per LOS). The number of cervical vertebrae involved in surgery, but not LB use, predicted opioid consumption on POD0, POD1, and total per LOS. For every vertebral level involved, 242 additional morphine milligram equivalents (MME) were consumed on POD0, 266 additional MME were utilized on POD1, and 130 additional MME were consumed in total per LOS.
ACDF patients who received intra-operative LB did not require fewer post-operative opioids or exhibit a decreased LOS compared to controls. Patients whose procedures involved a greater number of cervical vertebrae were associated with greater opioid consumption on POD0, POD1, and total per LOS. ACDF patients, especially those who had a high number of vertebrae involved, may require alternative analgesia to LB.
尽管脂质体布比卡因（LB）已被广泛使用，但证明其疗效的确切数据有限，尤其是在接受颈椎前路椎间盘切除融合术（ACDF）的患者中。因此，本研究调查了与未接受术中LB的ACDF患者（对照组）相比，接受术中LB的ACDF患者（LB组）术后阿片类药物使用量是否减少以及住院时间（LOS）是否缩短。
从机构数据库中识别出2016年至2019年由单一外科医生进行初次ACDF的82例患者。59例患者接受了术中LB，而23例未接受。收集患者特征、合并症、并发症、术后阿片类药物消耗量和LOS数据。
LB组在术后第0天、第1天、第2天或经LOS标准化后的整个住院期间（每LOS总计）所需的阿片类药物并不更少。手术涉及的颈椎数量而非LB的使用可预测术后第0天、第1天和每LOS总计的阿片类药物消耗量。每增加一个受累椎体水平，术后第0天额外消耗242毫克吗啡当量（MME），术后第1天额外使用266毫克MME，每LOS总计额外消耗130毫克MME。
与对照组相比，接受术中LB的ACDF患者术后所需的阿片类药物并不更少，LOS也未缩短。手术涉及更多颈椎的患者在术后第0天、第1天和每LOS总计的阿片类药物消耗量更高。ACDF患者，尤其是那些受累椎体数量较多的患者，可能需要LB以外的替代镇痛方法。
