Efficacy of Liposomal Bupivacaine for Pain Control in Pediatric Patients With Adolescent Idiopathic Scoliosis Undergoing Instrumented Posterior Spinal Fusion

Study Design. Retrospective Cohort Study Objective. This study aimed to compare perioperative pain outcomes in Adolescent Idiopathic Scoliosis (AIS) patients who either did or did not receive a liposomal bupivacaine (LB) injection during their posterior spinal fusion (PSF). Summary of Background Data. Liposomal bupivacaine (LB) has been promoted for its apparent long-lasting effects on pain management when compared to standard formulations. Many studies in adult spine populations have been carried out with varying results but few studies have investigated LB’s effect in the pediatric population. Methods. 472 pediatric patients with spine deformity undergoing posterior spinal fusion (PSF) between 2018–2024 were included. Starting early 2018, patients began receiving peri-incisional injections of LB by plastic surgeons during PSF closure (LB Group). These patients were compared to those that did not receive any injections (Non-LB [N-LB] Group). Pain scores, opioid consumption (MME), time to ambulation (out-of-bed/OOB), length of stay (LOS), narcotic refills, and 90- day complications were analyzed. Differences between the LB and N-LB groups were assessed using the Wilcoxon rank-sum test for continuous variables and either the chi-square test or Fisher’s exact test for categorical variables, as appropriate. A non-parametric analysis of covariance (ANCOVA) was conducted to compare pain scores at rest on POD1 and POD2, as well as morphine consumption during the first 24 hours and total morphine consumption. Results. 295 patients were in the LB Group, and 177 patients were N-LB. No differences were noted in demographics. Pain scores at rest were significantly lower on POD 1, POD 2, and overall ( P <0.05) in LB patients. LOS was significantly shorter in LB patients ( P <0.001). Significantly more patients were out of bed by POD 0 (59.9% vs. 38.0%, P <0.001) in the LB group. LB patients consumed significantly less opioids in 0-24 hours postop and during their total hospital stay ( P <0.001 and P =0.032, respectively). Conclusion. Patients who received liposomal bupivacaine had lower VAS pain scores at rest, opioid consumption, and length of stay with no increase in complications. This suggests that a long-acting local anesthetic formulation may offer superior pain management.