{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:33:04Z","timestamp":1793147584939,"version":"4.5.0"},"reference-count":45,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,23]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective study used the Pediatric Movement Disorders Center\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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\u2019s rehabilitation pathway during this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.6.peds26229","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:01:13Z","timestamp":1792540873000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["Liposomal bupivacaine utilization in the pain management of postoperative selective dorsal rhizotomy patients"],"prefix":"10.3171","author":[{"given":"Victoria A.","family":"Scott","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa","family":"Khoury","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.","family":"Hill","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, Houston;"},{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surya N.","family":"Mundluru","sequence":"additional","affiliation":[{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"},{"name":"Department of Orthopedics, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey L.","family":"Hall","sequence":"additional","affiliation":[{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"},{"name":"Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivedita","family":"Thakur","sequence":"additional","affiliation":[{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"},{"name":"Department of Pediatrics, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nischal","family":"Gautam","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingrui","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Science, McGovern Medical School at UTHealth, Houston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Pedroza","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simra","family":"Javaid","sequence":"additional","affiliation":[{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"},{"name":"Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M. L.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Fraser","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UTHealth, Houston;"},{"name":"Pediatric Movement Disorders Center, McGovern Medical School at UTHealth, Houston;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy: technical note","volume":"21","author":"Park TS","year":"2006","unstructured":"Park TS, Johnston JM. Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy: technical note. Neurosurg Focus. 2006;21(2):E7. doi:10.3171\/foc.2006.21.2.8"},{"issue":"12","key":"b2","series-title":"Dev Med Child Neurol","first-page":"1494","article-title":"Global prevalence of cerebral palsy: a systematic analysis","volume":"64","author":"McIntyre S","year":"2022","unstructured":"McIntyre S, Goldsmith S, Webb A,  Global prevalence of cerebral palsy: a systematic analysis. Dev Med Child Neurol. 2022;64(12):1494\u20131506. doi:10.1111\/dmcn.15346"},{"key":"b3","article-title":"Data and statistics for cerebral palsy","unstructured":"Data and statistics for cerebral palsy. Centers for Disease Control and Prevention. Accessed September 14, 2026. https:\/\/web.archive.org\/web\/20150403171209\/http:\/\/www.cdc.gov\/ncbddd\/cp\/data.html"},{"issue":"1","key":"b4","series-title":"Am Fam Physician","first-page":"91","article-title":"Cerebral palsy: an overview","volume":"73","author":"Krigger KW","year":"2006","unstructured":"Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73(1):91\u2013100."},{"issue":"9","key":"b5","series-title":"J Child Neurol","first-page":"1200","article-title":"Rehabilitative therapies in cerebral palsy: the good, the not as good, and the possible","volume":"24","author":"Damiano DL","year":"2009","unstructured":"Damiano DL. Rehabilitative therapies in cerebral palsy: the good, the not as good, and the possible. J Child Neurol. 2009;24(9):1200\u20131204. doi:10.1177\/0883073809337919"},{"issue":"11","key":"b6","series-title":"Phys Ther","first-page":"1534","article-title":"Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy","volume":"86","author":"Damiano DL","year":"2006","unstructured":"Damiano DL. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Phys Ther. 2006;86(11):1534\u20131540. doi:10.2522\/ptj.20050397"},{"issue":"1","key":"b7","series-title":"Dev Med Child Neurol","first-page":"140","article-title":"Physical, occupational, and speech therapy for children with cerebral palsy","volume":"62","author":"McCoy SW","year":"2020","unstructured":"McCoy SW, Palisano R, Avery L,  Physical, occupational, and speech therapy for children with cerebral palsy. 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Pediatr Neurosurg. 2007;43(2):107\u2013112. doi:10.1159\/000098382"},{"issue":"2","key":"b12","series-title":"Childs Nerv Syst","first-page":"239","article-title":"Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation","volume":"24","author":"Kan P","year":"2008","unstructured":"Kan P, Gooch J, Amini A,  Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation. Childs Nerv Syst. 2008;24(2):239\u2013243. doi:10.1007\/s00381-007-0457-8"},{"issue":"1","key":"b13","series-title":"Dev Med Child Neurol","first-page":"17","article-title":"Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials","volume":"44","author":"McLaughlin J","year":"2002","unstructured":"McLaughlin J, Bjornson K, Temkin N,  Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. 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