Local Infiltration Anesthesia with Liposomal Bupivacaine Decreases Postoperative Narcotic Consumption in AIS

Background: Our previous standardized postoperative pain management plan for AIS patients undergoing PSF included the placement of an epidural (EPI) catheter by spine surgeon prior to fascial closure. The was used 24 hours, in conjunction with a multi-modal post-operative protocol. Local Problem: 2020 COVID-19 pandemic highlighted need our surgical and their families have private rooms/bathrooms. Epidural catheters require arterial line blood pressure monitoring ensure safety. Unfortunately, lines could not be utilized rooms due lack appropriate monitors, therefore we transitioned away from epidurals. Liposomal bupivacaine (LB) is encapsulated local anesthetic that has duration action up 72 hours. Specific Aims: This quality initiative (QI) focused on enhancement care pathway PSF. aims were 1) minimize narcotic usage, 2) allow earlier mobilization. Intervention: (2020) LB cohort had mixture LB, HCL normal saline injected into subcutaneous layers incision (2019) control placed infusion consisted ropivacaine 0.1% (0.1-0.2 ml/kg/hr.) cohorts received same protocol (intravenous opioid transition oral opioid, as well dexmedetomidine, acetaminophen, ketorolac, diazepam). Measures Analysis: Two prospective underwent retrospectively reviewed. They compared regarding age, BMI, average preoperative major Cobb angle, kyphosis, VAS scores consumption. Time ambulation, length stay (LOS) also evaluated. Results: 159 There no differences between (n =101) 2019 EPI = 58) when comparing age (14.3 vs.15.0 years), BMI (21.7 vs.20.8 kg/m2), (60.7° vs.60.3°), or kyphosis (25.7° vs. 27.1°). consumed similar morphine equivalents during initial hrs. (37.8mg vs.37.3mg), but less at 24-48 (37.2mg vs 41.0mg) (p=0.031), 48-72hrs (23.3mg 29.6mg) (p=0.015). ambulated 6.8 sooner (17.1 23.9 hrs.) (p=.0001). Summary: associated consumption ambulation.