Combined Liposomal Bupivacaine and Dexamethasone Results in a Fivefold Reduction of Inpatient Opioid Use Following PSF in AIS Surgery
Presenter Status
Staff
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Anne Stuedemann MSN, RN, CPNP
Presentation Type
Poster
Start Date
19-5-2026 12:00 PM
End Date
19-5-2026 1:00 PM
Abstract Text
Background: Historically, our institution utilized intraoperative intrathecal morphine (ITM) or IV methadone with postoperative patient-controlled analgesia (PCA) for perioperative adolescent idiopathic scoliosis (AIS) pain management. To better align with Enhanced Recovery After Surgery (ERAS) principles and evidence-based opioid stewardship, we recently transitioned to intraoperative IV methadone combined with liposomal bupivacaine (LB) infiltration to optimize recovery and minimize opioid related harm.
Objectives/Goal: To evaluate the impact of an opioid‑reduction–focused quality improvement initiative within an Enhanced Recovery After Surgery (ERAS) pathway—specifically the elimination of patient‑controlled analgesia and the addition of peri‑incisional liposomal bupivacaine with 24‑hour dexamethasone—on in‑hospital opioid utilization, postoperative pain scores, and hospital length of stay among adolescents with idiopathic scoliosis undergoing posterior spinal fusion.
Methods/Design: A single-center, retrospective study of children with AIS undergoing initial PSF over a 6-year period was performed. Patients were subdivided according to their peri-operative pain pathway into 3 cohorts: intrathecal (IT)morphine, methadone-alone, or liposomal bupivacaine + dexamethasone (LB/Dex. Patients with IT morphine and methadone received a postoperative hydromorphone PCA managed by the anesthesia pain team whereas LB/Dex patients did not. Inpatient opioid usage was recorded using morphine equivalents (MME). Between group analyses were performed assessing opioid consumption, mean daily pain (measured by VAS), and length of hospital stay (LOS).
Results: A total of 159 patients were divided into three treatment groups: ITM (n = 88), LB/Dex (n = 35), and Methadone-alone (n = 36). Groups presented with similar demographic and surgical variables. There were significant differences across groups for outcome variables. The LB/Dex group compared to ITM/PCA and Methadone/PCA groups had significantly lower LOS (2.16 vs 2.8 vs 3.16, p < 0.001) and opioid use measured by cumulative MME (LB:29.6 vs ITM:162.1, M:199.1) and MME/kg (0.57 vs 4.13 vs 5.32, p< 0.038), with no significant differences between ITM and Methadone groups. Significant differences were also found favoring the LB group with lower daily opioid usage (MME/kg/day), IV MME, and oral MME (p < 0.001). Pain scores were lower in the ITM cohort postoperatively, but only clinically significant for POD 0.
Conclusions: Opioid stewardship is a critical element of postoperative pain management following posterior spinal fusion for adolescent idiopathic scoliosis. Implementing an ERAS-guided protocol-featuring liposomal bupivacaine, dexamethasone, and the removal of PCA-resulted in a five-fold reduction in inpatient opioid use, without compromising daily pain control.
Disclosures: An AI‑based language tool was used to assist with grammar and punctuation correction only. No content, analysis, or interpretation was generated by AI; all intellectual contributions are those of the authors.
Combined Liposomal Bupivacaine and Dexamethasone Results in a Fivefold Reduction of Inpatient Opioid Use Following PSF in AIS Surgery
Background: Historically, our institution utilized intraoperative intrathecal morphine (ITM) or IV methadone with postoperative patient-controlled analgesia (PCA) for perioperative adolescent idiopathic scoliosis (AIS) pain management. To better align with Enhanced Recovery After Surgery (ERAS) principles and evidence-based opioid stewardship, we recently transitioned to intraoperative IV methadone combined with liposomal bupivacaine (LB) infiltration to optimize recovery and minimize opioid related harm.
Objectives/Goal: To evaluate the impact of an opioid‑reduction–focused quality improvement initiative within an Enhanced Recovery After Surgery (ERAS) pathway—specifically the elimination of patient‑controlled analgesia and the addition of peri‑incisional liposomal bupivacaine with 24‑hour dexamethasone—on in‑hospital opioid utilization, postoperative pain scores, and hospital length of stay among adolescents with idiopathic scoliosis undergoing posterior spinal fusion.
Methods/Design: A single-center, retrospective study of children with AIS undergoing initial PSF over a 6-year period was performed. Patients were subdivided according to their peri-operative pain pathway into 3 cohorts: intrathecal (IT)morphine, methadone-alone, or liposomal bupivacaine + dexamethasone (LB/Dex. Patients with IT morphine and methadone received a postoperative hydromorphone PCA managed by the anesthesia pain team whereas LB/Dex patients did not. Inpatient opioid usage was recorded using morphine equivalents (MME). Between group analyses were performed assessing opioid consumption, mean daily pain (measured by VAS), and length of hospital stay (LOS).
Results: A total of 159 patients were divided into three treatment groups: ITM (n = 88), LB/Dex (n = 35), and Methadone-alone (n = 36). Groups presented with similar demographic and surgical variables. There were significant differences across groups for outcome variables. The LB/Dex group compared to ITM/PCA and Methadone/PCA groups had significantly lower LOS (2.16 vs 2.8 vs 3.16, p < 0.001) and opioid use measured by cumulative MME (LB:29.6 vs ITM:162.1, M:199.1) and MME/kg (0.57 vs 4.13 vs 5.32, p< 0.038), with no significant differences between ITM and Methadone groups. Significant differences were also found favoring the LB group with lower daily opioid usage (MME/kg/day), IV MME, and oral MME (p < 0.001). Pain scores were lower in the ITM cohort postoperatively, but only clinically significant for POD 0.
Conclusions: Opioid stewardship is a critical element of postoperative pain management following posterior spinal fusion for adolescent idiopathic scoliosis. Implementing an ERAS-guided protocol-featuring liposomal bupivacaine, dexamethasone, and the removal of PCA-resulted in a five-fold reduction in inpatient opioid use, without compromising daily pain control.
Disclosures: An AI‑based language tool was used to assist with grammar and punctuation correction only. No content, analysis, or interpretation was generated by AI; all intellectual contributions are those of the authors.
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Poster Board Number: 12