A Randomized Trial of Exparel vs Saline in Opioid Reduction of Pain Management Following Lumbar Spine Surgeries.

Launched by UNIVERSITY OF MISSOURI-COLUMBIA · Nov 19, 2020

Keywords

ClinConnect Summary

Multiple studies have shown that people who are taking opioids for acute pain have a greater likelihood of long-term opioid use. Many efforts have been made to reduce postop pain and opioid use, including developments in incisional site injections of local anesthetics, continuous incisional site anesthetic pain pumps, as well as multimodal comprehensive pain management, yet patients undergoing lumbar spine surgeries continue to depend on opioids for relief. Liposomal bupivacaine (LB) (Exparel) is a novel formulation of long-acting bupivacaine, lasting for up to 72 hours following injection....

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Eligibility criteria

• Inclusion Criteria:
• • Patients undergoing isolated lumbar spine procedures using a posterior approach.
• * Surgical spine procedures include:
• • Single-level lumbar spine surgeries with or without fusion
• • Multi-level lumbar spine surgeries with or without fusion
• Exclusion Criteria:
• • Procedures involving intrathecal space
• • Patients with documented allergy to local anesthetics (bupivacaine, lidocaine, procaine, benzocaine).
• • Acute lumbar trauma that requires immediate spine stabilization
• • Revision of failed back surgeries (including nonunion and malunion)
• • Revision of wound or hardware
• • Contraindication to regional anesthesia
• • Patients with chronic use of opioid medications
• • Liver dysfunction (INR \> 1.5, albumin \<2.8g/dl, bilirubin \>2mg/dl)
• • Renal dysfunction (eGFR \< 60ml/min/1.73m2)
• • Severe chronic obstructive pulmonary disease requiring continuous oxygen supplementation
• • Unable to give informed consent
• • Pregnancy