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This prospective, double-blind randomized trial compared liposomal bupivacaine (LB, 266 mg) with a modified cocktail of ropivacaine, epinephrine, dexamethasone, magnesium sulfate and sodium bicarbonate, both delivered via erector spinae plane block, in patients undergoing transforaminal lumbar interbody fusion. Of 181 screened patients, 118 were randomized equally to the two groups. Total postoperative rescue morphine consumption (primary outcome) was lower with LB (16.2 vs 22.6 mg; P=0.020), as were PCA activations (7.3 vs 17.6; P<0.001) and total PCA volume (33.4 vs 62.8 mL; P<0.001). Morphine use within 24 hours (7.1 vs 7.2 mg; P=0.894) and time to first rescue analgesia (P=0.074) did not differ significantly, and pain scores differed only at 24 and 36 hours. The authors conclude that the cocktail provides satisfactory analgesia within 24 hours at substantially lower cost, whereas LB offers more prolonged analgesia up to 36 hours.
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This prospective, double-blind randomized trial compared liposomal bupivacaine (LB, 266 mg) with a modified cocktail of ropivacaine, epinephrine, dexamethasone, magnesium sulfate and sodium bicarbonate, both delivered via erector spinae plane block, in patients undergoing transforaminal lumbar interbody fusion. Of 181 screened patients, 118 were randomized equally to the two groups. Total postoperative rescue morphine consumption (primary outcome) was lower with LB (16.2 vs 22.6 mg; P=0.020), as were PCA activations (7.3 vs 17.6; P<0.001) and total PCA volume (33.4 vs 62.8 mL; P<0.001). Morphine use within 24 hours (7.1 vs 7.2 mg; P=0.894) and time to first rescue analgesia (P=0.074) did not differ significantly, and pain scores differed only at 24 and 36 hours. The authors conclude that the cocktail provides satisfactory analgesia within 24 hours at substantially lower cost, whereas LB offers more prolonged analgesia up to 36 hours.
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