Exparel: What You Must Know

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In this video, we discuss the ongoing debate surrounding Exparel, a long-acting local anesthetic, and its potential to revolutionize postoperative pain management by reducing opioid reliance. Exparel is often misunderstood. In this video we break it down how some studies lead to misinterpretations, overshadowing Exparel's true potential.
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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:

7 сен 2024

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Комментарии : 25

@XXTheXXBoss Месяц назад

Huge thank you for this vital information

@nysoravideo Месяц назад

Glad if was helpful! Greetings!

@DrTuhinM Месяц назад

I totally agree with your views Prof. Hadzic.

@nysoravideo Месяц назад

Glad to hear this! Greetings from NYSORA!

@AlanZablocki Месяц назад

I did a lot of regional anesthesia, ultrasound guided nerve blocks & catheters. I never got to use Exparel because the P & T committees would not approve it. I was on P & T committees and I learned, over the years, that they may discuss the science behind the use of a drug, but they only really care about the cost.

@Lyraluca 25 дней назад

We have been using Exparel for over 5 years for proximal/above the clavicle brachial plexus approach with attention to administration into the subepineural space. Patients consistently report no pain for 3 days postoperative after arthroscopic shoulder surgery, shoulder arthroplasty, etc. Steve Orebaugh also reported on this in a similar fashion a couple of years ago. We have also used it successfully for femoral nerve blocks, with consistent 60-72 hours of postop analgesia. American academic anesthesiology is at best misguided.

@UNLIMITEDVISA Месяц назад

Adding precedex and decadron to local anesthesia for nerve blocks prolongs pain relief while eliminating the prolonged paralysis effects of local anesthesia. This alone could makes liposomal bupiv unnecessary

@kgan6653 16 дней назад

These agents prolong sensory block minimally compared to liposomal formulations- no pain killers needed on day 2 post-op with Exparel. You won't get that with decadron, Epi, Precedex etc.

@JuanFranciscoAsenjo Месяц назад

Do you know why the drug is not available in Canada?

@rambam111 Месяц назад

Nice informative analytics, thank you

@nysoravideo Месяц назад

Thank you for your comment! Greetings!

@GokageBlack Месяц назад

Why do you believe there is such a witch hunt... Trying to move practice away from blocks? Cost? I know some hospital pharmacists have pushed back but that seemed mostly related to block for the buck concerns.

@nicolascrescimone Месяц назад

Hospitals' pharmacy budget, they don't like us using exparel for every block. It's just expensive, but in my experience it works very well.

@nysoravideo Месяц назад

That is a good question. It is multifactorial. I believe that at the core is the lack of understanding of how this drug formulation works and how it needs to be administered and dosed. It is not a solution like local anesthetics, but a suspension, its dose is not immediately available for nerve block but is slowly released. That is why studies like the one we critiqued in the video, even by experienced researchers, flow. I believe that Pacira Pharma should have invested more time in education and research on its best uses, especially since the drug is expensive - at $300/vial. Its expense is relative, as using a perineural catheter costs more in time, equipment, and complexity of management. If Exparel became generic/cheaper - EVERYONE would use it. However - the price of the drug and its effectiveness are two different things.

@mbhardison Месяц назад

Agreed. 1000s of patients also agree.

@nysoravideo Месяц назад

Thank you for your comment! Greetings!

@nicolascrescimone Месяц назад

Do you know anyone trying epidural exparel?

@nysoravideo Месяц назад

Viscousi et al. have published on this: Epidurally administered liposome bupivacaine 266 mg resulted in a longer duration of sensory blockade than liposome bupivacaine 89 or 155 mg or bupivacaine HCl 50 mg. Duration of motor blockade was shorter with liposome bupivacaine 266 mg versus bupivacaine HCl. Reg Anesth Pain Med . 2012 Nov-Dec;37(6):616-22