The Effect of Exparil on Length of Stay for Outpatient Medialized Fusion

There has been significant attention towards moving spine surgery to the outpatient setting as a benefit to both payers and patients. Medialized spinal fusion is a minimally invasive technique that limits the exposure to the lateral border of the facet joints. Previous studies have demonstrated the feasibility of Medialized Lumbar Spinal Fusion in the outpatient setting. Perioperative pain management protocols are essential to developing a successful program. 

Hypothesis

We studied the effect of Exapril (pacira) on postoperative length of stay after Medialized Lumbar Fusion. 

Methods

This is a retrospective review of outpatient medialized fusion patients with and without Exparil. The surgeries were all performed by the author at the same center and all patients cleared anesthesia protocols deeming them candidates for outpatient surgery. Consecutive patients were reviewed and no cases were excluded. The same preoperative pain medication, intraoperative procedure, intraoperative local and regional injections (marcaine with epinephrine) as well as postoperative medications were utilized for all patients. 

Results

A total of 30 patients were in the study. 16 patients were in the Exparil and Marcain with epinephrine group and 14 patients in the local anesthetic (Marcaine with epinephrine) only group. The average length of stay for the Exparil group was 142 min(range 76-226) and the average length of stay for the local only group was 123 (range 42-294). No statistical significant difference was noted between the two groups after performing a two tailed T test p=0.33. 

Conclusion

We were unable to demonstrate any impact of Exparil on postoperative discharge times for medialized lumbar fusion patients in the outpatient setting. These findings are consistent with proposed mechanism of action of Exparil. Further studies looking at pain control after discharge over the 24-48 hours time frame are needed to determine if Exparil has a cost effective impact on outpatient medialized lumbar spinal fusion.