Exparel versus Plain Bupivacaine? - Crash course with Dr. Hadzic

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In this video, Dr Hadzic first talks about what’s his passion of brewing Luxury Belgian beer- DR BLUES BELGIAN BREWS (www.drblues.com) have to do with nerve blocks. He then goes on to discuss the February 2021 issue of the Journal of Anesthesiology which has an unusually strong statement on the cover page: “Liposomal Bupivacaine as Not superior to Standard local anesthetics”. In the meantime, the Drug-Maker of EXPAREL, Pacira has sued the Journal of Anesthesiology, which adds additional spice to this video. In the video, Dr Hadzic dissects the methodology and over-generalization in the 3 articles in the Journal that are used to support the statement on the Journal’s cover page. The video is highly informative read, in an entertaining journal-club style that helps the viewers understand that matter and learn how to critically evaluate the meta-analyses.
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's RU-vid channel is accurate.

Опубликовано:

30 сен 2024

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Комментарии : 35

@nysoravideo 2 года назад

DO NOT MISS OUT OUR NEW VIDEOS, SUBSCRIBE HERE: ru-vid.com

@henriquelaydner4080 2 года назад

First of all, congratulations on the reasoning. It’s really unusual to see such a hard statement about the usefulness of a medication. Secondly, I’m really looking forward to put my hands on a set of these beers. I hope they’ll eventually make it to Brazil.

@ravitiwary8733 2 года назад

Wishing you Happy New Year, Admir 💐💐

@deman601 2 года назад

This may rattle some people, but we need this type of discussion /critiques in order to improve- thank you and all the best in the new year!

@DRBLUESNYC 2 года назад

Hi De Man. Thank you for your comment. I hope that the video does not rattle anyone, as it is not meant to be offensive towards my colleagues, the authors of those papers. Rather, it is the result of the genuine concern about the future of regional anesthesia by thoughtlessly bashing novel pharmacology that is desperately needed for RAPM to transition to the next level of clinical utility. Nearly 80 pages of the Journal space with inadequately thought through bash of the potentially useful new formulation is flippancy, undermines the credibility of the Journal, as well as threatens the future pharma developments that are sorely needed in RAPM. Happy New Year!

@JustPeaceLoveAndKindness 2 года назад

I have used Exparel in many pts and received it as a pt personally. These misuse of metaanalysis and efforts to misrepresent the benefits of this formulation is a ethical problem in medicine where authors place their personal gains ahead of benefit to pts. Thank you for speaking out, and calling out the flaws of these naysayers.

@DRBLUESNYC 2 года назад

Hi Sleepkeeper! I agree that meta-analyses are often misused. The result of a meta-analysis is so dependent on what you put into it, and what you set as the meaningful outcome variable/signal for the meta-analysis to be positive. In this meta-analysis, the inclusion of underdosed, unpublished, and experimental data + too high of an outcome expectation (delta) - are the flows for which this one should not have been published as such a "definitive" verdict on the efficacy of the drug in perineural applications. Perhaps as an explorative meta-analysis. The paper's discussion on how the results would not be even statistically different if you excluded one industry-supported study, while that was the only study that went through 4 months of scrutiny, and as many as 2 audits for data integrity and ethical conduct, and stood the tests, is inappropriate. I do not believe that the authors had other gains in mind but a scientific communication, a publication, that had gone wrong with the overstating and overgeneralizing. The journal's definitive stance on the cover page, which reads like a tabloid, pitching to attract readers, can indeed be damaging to the drug maker, patients, and the future of regional anesthesia and interventional pain management, IMO. The latter is my primary motivation for sharing this, as it is where the benefits lie for all stakeholders.

@ravitiwary8733 2 года назад

I can’t believe how a study can be so deeply flawed and that too for publication in a reputed journal.

@DRBLUESNYC 2 года назад

Indeed. The long-standing reputable journals are generally considered as unconditional bastions of credibility. Typically, they are not challenged, although the Journals are for-profit outlets for publishing houses. And that is probably why they increasingly more often resort to sensational, tabloid-like content as is the case with the February cover page. It appears that they are departing from the strict, scientific approach of the past, toward tabloid journalism to attract more subscribers. We may learn invaluable lessons from the outcome of the lawsuit, and its wider discovery. However, the lawsuit, whatever the outcome - may restore the balance and curb the increasingly greater monopoly by the Journals and their publishers. That is why I personally applaud the PACIRA's legal move, whatever the outcome, and hope that its proceedings are not too disruptive to my colleagues, the authors, as such process - however, needed - is not fun or easy.

@christadagnese3278 2 года назад

🙌🏻🙌🏻

@katklub2573 2 года назад

Happy New year Dr .Hadzic

@ymc7496 2 года назад

This topic showed up as a question on my MOCA minute this quarter. 🤦🏻‍♀️. They should have watched your video first. Can you do more of these types of videos please? I just shared it with a bunch of people.

@DRBLUESNYC 2 года назад

Hi YM C. THanks for letting us know. That is another really wrong thing to do - publishing something that the readers can interpret themselves as to what it means in their own clinical practice is one thing. But, selling CME credits based on the information that can negatively affect patient care and our subspecialty is wrong.

@manuelo3331 2 года назад

Thanks Hadzic for always strengthening my love for regional A. and stimulating a research topic on this corner of the globe even though the Exparel is not available yet in our Market.

@nysoravideo 2 года назад

Hey Manuel! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!

@paulsdrc Год назад

Experal is awesome, no goofy feeing, no numbness, no pain, everything felt normal.

@rachelgooden9981 2 года назад

GOAT

@DRBLUESNYC 2 года назад

Thank you Rachel. Telling it like it is. Happy New Year!

@rachelgooden9981 2 года назад

It was great seeing you this past week.

@chaltimepass 2 года назад

Admir.. U have taught us how to analyse the studies! Gr8 discussion!

@DRBLUESNYC 2 года назад

Thanks. Happy New Year!

@dianelislisabet4032 2 года назад

Thanks and happy new year Dr!😷

@claudio9932 2 года назад

Great videos in general with excellent discussion or at least motivation to discuss all aspects of regional and local blocks. As a board certified veterinary anesthesiologist I truly enjoy your videos, thank you. 😊

@nysoravideo 2 года назад

Hi Flu Vet! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!

@zelmile 2 года назад

Question to Dr Hadzic: In our hospital we use a lot of Ropivacaine 5mg/ml and 7,5mg/ml. We use POP block for bigger ankle and foot surgery. We have catheters which we use rarely, but some of our patients would benefit from longer blocks. What do you think of using liposomal Bupivacaine together with Ropivacaine 5mg/ml for popliteal block to prolong its duration in stead of catheter? Kind regards

@DrMRod Год назад

I’m not Dr. Hadzic obviously, but the manufacturer states that only plain bupivacaine can be mixed with liposomal bupivacaine (or injected sequentially in the same site) otherwise you risk disrupting the lysosomes causing immediate release of the bupivacaine and risking LAST.

@paulsdrc 2 года назад

Exparel is awesome, I’ve received it after several major surgeries. Because of it I was off all other pain meds by the time I was discharged.

@nysoravideo 2 года назад

Dear paulsdrc! Thank you for watching our channel. And wishing you best for your recovery. Greetings from Nysora Team!!

@brevinoconnor1262 Год назад

Any thoughts on micellular bupivacaine? such as the 2019 ACS Nano article, 13, 18−25? Could that form of delivery be promising for future anesthesia delivery?

@rachelgooden9981 2 года назад

I can’t wait to try that beer. Wish you had brought some with you to Orlando!

@neals8596 2 года назад

Impressively sexist, shameful imagery used by Dr Blues. You've deftly embarrassed yourself and your program by promoting the absurdity of their artwork. At a time when across the world women (and many other members of our communities) struggle for respect and support. You've failed them by shilling for this business

@nysoravideo 2 года назад

Our profile is public, so you know who we are. Visiting your “Neal S” profile on RU-vid does not show any info about you, videos, playlists, etc. Let us know your identity so that so that the viewers can chime in about your point of view. Otherwise, if indeed offensive, it would make sense to unsubscribe.

@norahbianculli4429 2 года назад

I actually think the artwork is super cool - it's done in the vintagey art style of 1950s posters and is obviously implying that. Thanks for being an ally, but I don't think leaving comments on an *educational anesthesiology video* is going to change the world, nor that art in any form needs changing to adapt to societal pressures...

@DRBLUESNYC 2 года назад

Hi Neal. As a medical professional, I find your statement morbidly perverse. Only a sexist can see sexism in retro-art. My statement is public, yours is behind the mask. Come out and let's have an open and socially responsible discussion about sexism versus art. Greetings.