Liposomal bupivacaine utilization in the pain management of postoperative selective dorsal rhizotomy patients.

OBJECTIVE

Selective dorsal rhizotomy (SDR) is a procedure commonly utilized to treat spasticity in children with cerebral palsy. Limited studies have evaluated postoperative pain management with the objective of opiate dosage reduction. This retrospective cohort study examined the role of liposomal bupivacaine (LB) in postoperative pain management and the outcomes of SDR patients.

METHODS

This retrospective study used the Pediatric Movement Disorders Center's prospective database to query electronic medical records for demographic, surgical, and postoperative data for all patients who underwent SDR from 2023 through 2025. Patients were divided into two groups: those treated with 0.25% bupivacaine HCl (comparison group) or a mixture of LB and bupivacaine HCl (LB group). Both modalities were administered via local infusion during closure of the SDR incision. All patients also received our previously developed protocol that includes infusion of dexmedetomidine during SDR surgery combined with perioperative gabapentin and scheduled acetaminophen and nonsteroidal anti-inflammatory drugs postoperatively, henceforth referred to as the dexmedetomidine infusion (INF) protocol.

RESULTS

Operative duration, postoperative opioid and nonopioid medication administration, and therapy notes were collected for 41 patients. Patients who underwent SDR between May 2023 and July 2024 received our INF postoperative pain management protocol and bupivacaine HCl (comparison group [n = 20]). Patients who underwent SDR between October 2024 and July 2025 received INF along with a mixture of bupivacaine HCl and LB (LB group [n = 21]). Differences in demographic characteristics, preoperative Gross Motor Function Classification System (GMFCS) scores, operative duration, hospital length of stay (LOS), and postoperative opiate/nonopiate medication administration were recorded. When converted to morphine milligram equivalent, there were no significant differences in opioid dosage or total opioid use between groups. There was a trend toward significance, in that the comparison group participated in physical therapy for a longer duration than the LB group on postoperative day 2. This was attributed to differences in discharge dates between the two groups: the LB group was more likely to be discharged on postoperative day 2 than the comparison group due to changes in our center's rehabilitation pathway during this study.

CONCLUSIONS

Local infiltration of LB mixed with standard bupivacaine, given at the conclusion of SDR surgery in conjunction with our established postoperative pain management protocol, was not associated with decreased use of postoperative pain medications when compared to the infusion of standard bupivacaine.