Erector Spinae Plane Block With Liposomal Bupivacaine for Adolescent Idiopathic Scoliosis Surgery: No Patient-controlled Analgesia Needed

Abstract

Study design: Retrospective controlled cohort.

Objective: To evaluate the effect of intraoperative liposomal bupivacaine (LB) through erector spinae plane block (ESPB) on patients with postoperative adolescent idiopathic scoliosis (AIS) with and without patient-controlled analgesia (PCA).

Background: Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities. The goal of these modalities is to reduce pain and opioid consumption. Two new modalities for pain control include LB and ESPB. There are scant studies on these modalities tested in concert on patients undergoing PSF for AIS.

Patients and methods: Seventy-two consecutive patients with AIS who underwent PSF were separated into patients who had a PCA (group A) as part of their postoperative pain management and those who did not (group B). Opioid consumption was measured through morphine milligram equivalents. Pain scores were measured through the visual acuity score (Visual Analog Scale). Patient mobility was measured by steps taken. These were measured by the function of postoperative days from surgery.

Results: Group B had significantly lower morphine milligram equivalents at every point after surgery, most notably throughout the entire hospital stay (99.8 vs . 200.7). Postoperative pain scores in group B were the same if not better than group A. There was no difference in mobility between the cohorts. Group B had lower LOS (3.7 vs . 4.1).

Conclusion: In postoperative PSF for patients with AIS receiving LB through ESPB, those who did not receive a PCA had lower opioid consumption without worse pain scores or mobility and had a lower LOS. Adding LB through ESPB to postoperative pain regimens effectively replaces a PCA by providing the same pain control and reducing overall opioid consumption and LOS.