The Emerging Role of Liposomal Bupivacaine in Erector Spinae Plane Blocks for Post-Operative Pain Management in Spine Surgeries: A Narrative Review

Postoperative pain is a common consequence of spinal operations related to tissue trauma, manipulation of neural structures, and lengthy procedures. While opioid medications are frequently used for pain control, their side effects, such as nausea, vomiting, tolerance, and dependency, have led to increased interest in multimodal analgesic techniques. This review aims to examine effectiveness and safety of liposomal bupivacaine (LB, EXPAREL) in erector spinae plane blocks (ESPB) for postoperative pain management following spinal surgery. Regional anesthesia methods, particularly ESPB, have gained attention in reducing opioid requirements. The ESPB technique involves ultrasound-guided administration of local anesthetics beneath the erector spinae muscles and above the transverse process, effectively inhibiting ventral and dorsal rami of spinal nerves. Despite its popularity for versatility and safety, the analgesic effects of ESPB with conventional local anesthetics are relatively short-lived. LB, which releases the drug gradually as liposomes are degraded, offers extended pain control. Early clinical applications in pediatric scoliosis surgery and transforaminal lumbar interbody fusion have revealed that ESPB with LB adequately outperformed the control analgesic in terms of opioid consumption (30% and 50% decrease in mentioned studies) and length of stay (24%, 32%, and 12% decrease in mentioned studies). These findings indicate that LB in ESPB represents a promising strategy for enhanced perioperative pain management in spinal procedures. However, further research with larger and more diverse patient populations and outcome measurements are needed to overcome the current limitations of current research. In the present investigation, current evidence regarding the implementation of LB in ESPB during spine surgeries is summarized, focusing on safety and potential to improve patient outcomes by prolonging analgesia, minimizing opioid use, and promoting faster recovery.