Retrospective Assessment of the Use of Liposomal Bupivacaine in Lumbar Fusions in Immediate Postoperative Hospital Care.

BACKGROUND: Liposomal bupivacaine (LB) is approved by the U.S. Food and Drug Administration for administration into surgical sites for postsurgical analgesia. The liposomal formulation allows for sustained effects up to 72 hours. METHODS: A retrospective study assessed patients undergoing lumbar interbody surgery. Visual analog scale pain scores and amount of opioids consumed were recorded at 12-hour intervals for 72 hours postoperatively, as were patterns of discharge and hospital length of stay (LOS). RESULTS: A total of 122 patients (97 LB vs. 25 control group) were reviewed. Median LOS was shorter in the LB cohort compared with controls (1.94 vs. 3.08 days, respectively; P = 0.0043). When assessing the percentage of discharges between groups at 12-hour intervals, there were significantly more discharges in the LB cohort at 36-48 hours (P = 0.0226), and no differences elsewhere. There was a decrease in intravenous opioids consumed at 48-60 hours in the LB cohort compared with controls (P = 0.0494), a difference not detected at other time points or with oral or total opioids. Mean visual analog scale scores were significantly higher in the LB cohort compared with controls at 0-12 hours (5.2 vs. 3.9, respectively; P = 0.0079), but insignificantly different subsequently up to 72 hours. The LB cohort and controls were not significantly different in total amount of opioids consumed, overall pain scores, or regarding how the opioid amount consumed or pain scores changed over time. CONCLUSIONS: The use of LB in lumbar interbody fusion decreases patients' LOS but has little effect on reducing overall pain scores or opioid use in the 72-hour postoperative hospital period.

Critical illness polyneuromyopathy.

PURPOSE: The clinical characteristics of and treatment approaches for critical illness polyneuromyopathy (CIPNM) are reviewed. SUMMARY: CIPNM is an acute axonal sensory-motor polyneuropathy that tends to occur after the development of respiratory insufficiency in patients with systemic inflammatory response syndrome, sepsis, or multiple-organ dysfunction syndrome. Numerous mechanisms have been proposed to explain the pathophysiology of CIPNM, most of which are complex and not fully understood or proven. While the rate of intensive care unit-acquired weakness varies greatly among patients, an estimated 25-85% of critically ill adult patients will develop neuromuscular weakness, most commonly CIPNM, during hospitalization. While no specific pharmacologic treatments exist for CIPNM, the outcome for most patients is related to the severity of the illness and neuromyopathy, as well as early intervention to treat the underlying condition. Electrophysiologic studies, such as electromyography, electroneurography, and muscle and nerve biopsies, are considered the gold standard for aiding in the diagnosis of CIPNM. Preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications such as corticosteroids and neuromuscular blocking agents (NMBAs) can help reduce the occurrence of CIPNM. CONCLUSION: CIPNM is an acute axonal sensory-motor polyneuropathy commonly seen in critically ill patients with sepsis and multiorgan failure. While no specific pharmacologic treatments exist, preventive measures such as the early provision of appropriate nutrition, glucose control, physical rehabilitation, and the cautious use of medications, including corticosteroids and NMBAs, can help reduce the incidence of CIPNM.