Bad news for exparel

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It seems that good old Bupivacaine is better than Exparel for periarticular infiltration:

Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty.
Bagsby DT, Ireland PH, Meneghini RM.
Author information
  • Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana.
Abstract
The purpose of this study was to compare a novel liposomal bupivacaine to traditional peri-articular injection (PAI) in a multi-modal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared 85 consecutive patients undergoing TKA with a traditional PAI of ropivacaine, epinephrine and morphine to 65 patients with a liposomal bupivacaine PAI. After the initial 24h, inpatient self-reported pain scores were higher in the liposomal bupivacaine group compared to the traditional PAI group (P = 0.04) and a smaller percentage (16.9%) of patients in the liposomal bupivacaine group rated their pain as "mild" compared to the traditional group (47.6%). Liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control program in patients undergoing TKA.
Copyright © 2014 Elsevier Inc. All rights reserved.
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Yep. 50% of our orthopods have gone back (or will be going back) to traditional cocktail. The thing is, the cat is already out of the bag.

One of the directors of pacira did just sell over 2 million worth or stock. :thinking:
 
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Members don't see this ad :)
http://www.intercooleronline.com/st...tor-unloads-21494-shares-of-stock-pcrx/76935/

Pacira Pharmaceuticals (NASDAQ:pCRX) Director Andreas Wicki unloaded 21,494 shares of the stock in a transaction dated Friday, August 29th. The stock was sold at an average price of $108.11, for a total transaction of $2,323,716.34. The sale was disclosed in a document filed with the Securities & Exchange Commission, which is available at this link.

A number of research firms have recently commented on PCRX. Analysts at Wedbush raised their price target on shares of Pacira Pharmaceuticals from $98.00 to $110.00 in a research note on Friday, August 1st. Separately, analysts at Canaccord Genuity raised their price target on shares of Pacira Pharmaceuticals to $114.00 in a research note on Friday, August 1st. Finally, analysts at Jefferies Group reiterated a “buy” rating on shares of Pacira Pharmaceuticals in a research note on Friday, August 1st. They now have a $109.00 price target on the stock, up previously from $86.00. One research analyst has rated the stock with a hold rating and seven have issued a buy rating to the stock. The stock has an average rating of “Buy” and an average target price of $104.68.

Of course, you can't believe everyting you read. Tread with caution and know your stocks.
 
Anyone have good things to say about orthopod tricapsular injection of local anesthetic as the only postop pain measure of TKAs? We have always had their support in doing FNB, ACB, SNB, do I honestly don't know how effective that joint injection is.
 
Oggg said:
Anyone have good things to say about orthopod tricapsular injection of local anesthetic as the only postop pain measure of TKAs?
Click to expand...

Hit or miss. Highly patient and surgeon dependent.
 
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I think that is one reason Exparel has some PRO studies and a bunch of no-benefit studies. Surgeons shoot local haphazardly I've got one who believes in squirting 10cc marcaine into the hernia wound before closing up (no needle). None of my orthopods report looking for three gutters or capsules to inject into for TKA. Our ultrasound guided blocks however, have a higher degree of precision, so I am betting that these studies should really show a better longer block. As long as they get into the sheath -- marcaine outside the sheath for a FNB acts like a FICB. Only 12h. I think Exparel is a winner UNLESS someone else comes up with a better delayed release formulation (DURECT)
 
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Oggg said:
... 've got one who believes in squirting 10cc marcaine into the hernia wound before closing up (no needle).
Click to expand...

That's called a "splash" block. Google it. If it's along the fascial plane it's a perfectly acceptable technique.
 
You guys don't get Exparel. It's truly an amazing local anesthetic. It will transform Regional in many hospitals which don't use pumps/catheters.

PCRX will easily double from here over the next 36 months.
 
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Hope you guys are getting some Alibaba before the ipo tomorrow. I expect it to be super solid. Look at what it's done to yahoo.

The thing about exparel is that you can't titrate it... and I can't really tell a big difference btw/ exparel for joints and standard cocktail. But it's the new kid on the.block.
 
Better yet, just buy YHOO stock. Yahoo will most definitely benefit as much or more from the Alibaba ipo since they were just upgraded and they own 22.5% of alibaba.
The Alibaba IPO is going to generate a lot of excitement. There have been a lot of doubts about the actual growth prospects. Instead, buy proven stocks that will benefit from the deal and check in next year to see how well it develops. Then make your decision at that time based on reality and performance.
 
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BLADEMDA said:
You guys don't get Exparel. It's truly an amazing local anesthetic. It will transform Regional in many hospitals which don't use pumps/catheters.

PCRX will easily double from here over the next 36 months.
Click to expand...

I would love to invest in PCRX but Im going to stick to the fundamentals. I have to fight the urge.

Plus its forward P/E is 189! Thats just too scary of a number for me. I probably already missed the boat and Ill end up being the sucker who buys high and sells low.

But still the urge......
 
Noyac said:
Better yet, just buy YHOO stock. Yahoo will most definitely benefit as much or more from the Alibaba ipo since they were just upgraded and they own 22.5% of alibaba.
The Alibaba IPO is going to generate a lot of excitement. There have been a lot of doubts about the actual growth prospects. Instead, buy proven stocks that will benefit from the deal and check in next year to see how well it develops. Then make your decision at that time based on reality and performance.
Click to expand...

Too late... I'm in 50K pre- IPO. My ortho buddy bought 200K pre-IPO. We will see how things go. I'm hoping it won't be a facebook flop... I doubt it tho. Picked up yahoo about a month ago. That was a good move. ;)

Wish me luck tomorrow.

:luck:
 
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"....The classic 1991 study on the subject by Jay Ritter in Journal of Finance, for example, showed that initial public offerings (IPOs) produced a first-day pop of 16%, then underperformed the market by an average of 28% over the next three years. From the perspective of the first-day return, the average IPO is "underpriced," designed as a bon-bon to preferred brokerage customers. The "success" of the IPO is thus defined by the profit provided to these initial purchasers, who are favored by the wirehouses in the same way that casinos favor the highest rollers. That the issuing company and the later purchasers do not come out so well doesn't seem to enter into this rather perverse calculus of success..."

William Bernstein, MD-PhD and finance writer

http://www.efficientfrontier.com/ef/0adhoc/fb.htm
 
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dr doze said:
"....The classic 1991 study on the subject by Jay Ritter in Journal of Finance, for example, showed that initial public offerings (IPOs) produced a first-day pop of 16%, then underperformed the market by an average of 28% over the next three years. From the perspective of the first-day return, the average IPO is "underpriced," designed as a bon-bon to preferred brokerage customers. The "success" of the IPO is thus defined by the profit provided to these initial purchasers, who are favored by the wirehouses in the same way that casinos favor the highest rollers. That the issuing company and the later purchasers do not come out so well doesn't seem to enter into this rather perverse calculus of success..."

William Bernstein, MD-PhD and finance writer

http://www.efficientfrontier.com/ef/0adhoc/fb.htm
Click to expand...

You're the king of investing on this board... no doubt... :thumbup: and I agree with you 100%. I've done some serious reading up on this company and the funds come out of my play money account... which has done well. So these are funds I'm willing to loose completely. I wouldn't touch my retirement accounts on something like this. Now if it can do just as well as BAIDU on its opening day...

Baidu%20Google_3.jpg


Yeah... right. That'll never happen.

275 million subscribers though... and 8% of all internet sales in China. o_O

I do think that irrespective of what it does the first year, it's long term prosperity is very certain.
 
Thanks for the compliment. Another quote from Dr. Bernstein on China:

"Brokerage houses and mutual fund companies often tout the stocks of emerging-market nations, such as Brazil, Russia, India, and China (the so-called BRIC countries) because of their rapid economic growth. But beware: Share dilution, and often outright theft because of lax security laws, vaporizes a lot of this growth by the time it reaches the per-share level. For example, China’s economy has been growing at a blistering 9 percent real rate per year for more than two decades. Yet between 1993 and 2008 investors actually lost 3.3 percent per year in Chinese stocks, even with dividends reinvested. You read that right: Over this 16-year period, even before expenses, the investor in Chinese stocks lost 41.5 percent of value.4 (The loss of 3.3 percent per year before inflation calculates out to a loss of 5.7 percent per year after inflation.)"


Glad that it is just play money. At the end of the day I just don't trust a country that can't provide clean air for its citizens to breathe, untainted food to eat, clean water to drink to care very much about the rights of foreign shareholders. I still own china via emerging markets funds. Probably comprises about 2% of my portfolio.
 
Alibaba is cheap. If you can get it at the Ipo price it is worth $90 per share.

I'd be willing to do $50k The conservative Ipo price. I expect a $15 pop on the first day of trading.
 
dr doze said:
At the end of the day I just don't trust a country that can't provide clean air for its citizens to breathe, untainted food to eat, clean water to drink to care very much about the rights of foreign shareholders. I still own china via emerging markets funds. Probably comprises about 2% of my portfolio.
Click to expand...

Yup. You need to be willing to swallow that first. This is a source of great criticism w/ regard to the IPO.
 
sevoflurane said:
Too late... I'm in 50K pre- IPO. My ortho buddy bought 200K pre-IPO. We will see how things go. I'm hoping it won't be a facebook flop... I doubt it tho. Picked up yahoo about a month ago. That was a good move. ;)

Wish me luck tomorrow.

:luck:
Click to expand...


You are going to make 30 percent in 1-2 days. Smart move.
 
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Back to Exparel

That knee study - anyone could have predicted the outcome without the trial. That doesn't speak at all poorly of Exparel. At best, it means we need to figure out how to best use it.

Think of this - I Lets assume a surgeon uses 50CC of 0.5% bupviciane around the knee joint. That is 250mg of bupivicaine, all available to be used immediately. Let's assume this last 12 hours. That is gives a hourly caine rate (something I just made up) of ~21mg/hr. Exparel, on the other hand, will have an hourly caine rate of ~4 mg/hr. Obviously the free bupiviciane will work MUCH better on a very painful area, initially. And the study said that in the first 24 hours, the free "cain" worked better than the liposomal "caine". Duh. That is why for painful things, people are mixing the exparel with free bupiviciane to help with the painful stimulus right up front.

Sevo, your ortho - ***** will likely switch back. They need to work harder on learning how to use it properly.

Regarding the stock - they have about 2% of the market. Think about that number for a second. They are selling vials like crazy, and they have really only penetrated a VERY SMALL piece of the market. I teach at ultrasound courses and a shocking number of people haven't used or heard of it. However, what also surprises me also, is how small private hospitals are using it like crazy - because it SAVES THEM MONEY. That is what really blew me away, that hospitals that mostly care about the bottom line, are buying it up like crazy. That to me is very telling.

Finally, a word about insiders selling stock. It has always been a very strange thing to me that outsiders seem to think that insiders should never make money - or that they need to keep all eggs in one basket, yet EVERY BOOK or pundit will say - diversify. Yet somehow people with money in the company they work for are suppose to completely ignore this advice? Plus, for months people have been predicting a 10-20% pullback - yet a savvy investor in a company can't head these warnings? It is all very strange to me that wall street investors don't hold the same standard to everyone. Also, options expire and sometimes they HAVE to sell.

The thing Exparel needs to worry about is that new product I just read about from an Australian study - 12% bupivicaine or something - 5mls injected into surgical field.
 
  • Reaffirming our wide moat and stable moat trend ratings. Alibaba's recent top-line growth trends have been supported by an increase in the number of active buyers and sellers, supporting the network effect underpinning our wide moat rating. We continue to believe that structural differences in China's retail industry and Alibaba's mobile investments will protect its network effect, even as China moves from a consumer-to-consumer to a business-to-consumer e-commerce market, resulting in a stable moat trend.
  • Our $90 per ADS fair value is based on a revenue CAGR of 32% and operating margins expanding to 50.2% from 47.5% over the next five years. Our top-line assumptions are due to several macroeconomic, socioeconomic, regulatory, and industry growth drivers, while a scalable third-party platform should allow Alibaba to generate margins well ahead of its peers.
  • Assigning Alibaba high uncertainty and poor stewardship ratings. We've assigned a high uncertainty rating based on competitive, regulatory, and execution risks, while our poor stewardship rating balances management's solid execution with concerns about its variable interest entity (VIE) structure, partnership committee, and Alipay transference.



Conservative IPO Pricing Range Underappreciates Alibaba's Longer-Term Potential, but Investors Must Understand the Risks
 
BLADEMDA said:
You are going to make 30 percent in 1-2 days. Smart move.
Click to expand...

It only works that way if it both goes up 30% and you completely sell the position when it's up 30%. For many investors, when a stock skyrockets up, they don't sell. Sometimes they even buy more. Then it starts tumbling and they have to try to figure out when to time it to get out.

Buy low, sell high is the game. Buy high, sell low is the emotion. Most people can't stick to it like they want to.
 
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BLADEMDA said:
  • Our $90 per ADS fair value is based on a revenue CAGR of 32% and operating margins expanding to 50.2% from 47.5% over the next five years. Our top-line assumptions are due to several macroeconomic, socioeconomic, regulatory, and industry growth drivers, while a scalable third-party platform should allow Alibaba to generate margins well ahead of its peers.
Click to expand...

I particularly love it when "gurus" pretend like they know what earnings and revenue and operating margins will be 5 years from now. They can't even give a statistically accurate guess as to what they will be 6 months from now, but they pretend like they can be spot on 5 years out? Those same idiots were singing the praises of every dot com stock in 1999 that had a P/E ratio of 200 and could only go higher. I mean if you go back and read actual quotes from actual respected people right before bubbles burst, it's comical in hindsight.

March 10, 2000 - NASDAQ his all time high. Market strategist Ralph Acampora of Prudential Securites says "Norfolk Southern (railroad) or Cisco Systems: Where do you want to be in the future?" In the next 12 months, Norfolk Southern's stock was up 35% while Cisco dropped 70%.

Heck on May 14, 2014 the same Ralph Acampora (godfather of technical analysis) suggested the S&P would drop 10-15% by October. It closed at 1888.53 that day. This morning it is about 2017. He needs it to drop about 300 points in the next 6 trading days to be even close to correct.

Predictions of the future for individual stocks or even entire indices are just wild ass guesses. Even by the smartest people around, they are guesses and they are often wildly wrong. I just love watching them keep make those predictions and keep acting like they know.
 
BLADEMDA said:
Alibaba is cheap. If you can get it at the Ipo price it is worth $90 per share.

I'd be willing to do $50k The conservative Ipo price. I expect a $15 pop on the first day of trading.
Click to expand...

Looks like that is going to happen as soon as it starts trading. Price is up to $83-85 from $68 per share. This is only an indicator though.
 
:banana::banana:

We are up about 40%!!!

Dang... my ortho buddy is stoked. Should have followed suit, but I'm still pretty happy!
 
sevoflurane said:
:banana::banana:

We are up about 40%!!!

Dang... my ortho buddy is stoked. Should have followed suit, but I'm still pretty happy!
Click to expand...

Hey sevo, am I missing something?

I thought unless you somehow had IPO allocation, you could only buy the stock at its opening price. I read that for an individual its next to impossible to buy it before its publicly traded. That means you would of had to buy it at the $92.70 (opening price)
 
RxBoy said:
Hey sevo, am I missing something?

I thought unless you somehow had IPO allocation, you could only buy the stock at its opening price. I read that for an individual its next to impossible to buy it before its publicly traded. That means you would of had to buy it at the $92.70 (opening price)
Click to expand...

A lot of those shares were sold pre-market at the IPO price or below depending on who you know and their relations with Alibaba. I really didn't want to get into this, but read what Doze initailly posted yesterday. There is a lot of truth to that post (as per usual).

Goldman Sachs had a key role in the IPO today.
 
sevoflurane said:
A lot of those shares were sold pre-market at the IPO price or below depending on who you know and their relations with Alibaba. I really didn't want to get into this, but read what Doze initailly posted yesterday. There is a lot of truth to that post (as per usual).

Goldman Sachs had a key role in the IPO today.
Click to expand...

Correct. The brokers always make money. Sometimes they throw a bone to some of their preferred customers and let them in on some of the profit. It's the suckers that buy on the open market the first day that usually lose.
 
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While I agree with Mman, I also believe Alibaba has been and is going to continue to become a big chunk of many mutual funds. Just like Apple, Google, Exxon, etc.
That means there is a demand for it outside of individual investors.
 
Physicians can be Preferred clients for brokers. I suspect Sevo and his ortho buddy got in at around $62-$68 per share. Usually, they offer up to 1,000 shares to good clients. The ortho guy must have been a VERY GOOD client.
 
So if it jumped 40%, they priced it wrong for the ipo, right? They could have raised 40% more money.
 
caligas said:
So if it jumped 40%, they priced it wrong for the ipo, right? They could have raised 40% more money.
Click to expand...


No. Brokers expect a 20% jump in the opening price. It's a game. If the IPO is priced correctly the stock goes up on opening day. Could they have gotten $75 per share for the IPO? Yes. $90? No.
 
we reviewed that article in journal club. it's poorly done and the conclusions drawn from it are meh. 2 surgeons, no discussion on TECHNIQUE of injection, which is paramount for exparel given that it cannot diffuse, and the difference of 0.4 in pain scores if i recall correctly is not even clinically relevant.
 
BLADEMDA said:
No. Brokers expect a 20% jump in the opening price. It's a game. If the IPO is priced correctly the stock goes up on opening day. Could they have gotten $75 per share for the IPO? Yes. $90? No.
Click to expand...

Well that hardly seems fair :)
 
sevoflurane said:
A lot of those shares were sold pre-market at the IPO price or below depending on who you know and their relations with Alibaba. (as per usual). ]
Click to expand...

Thats awesome dude. Im happy when guys like you get in on the real profits. Usually its the investment bankers making the mega rich richer while we duke out the scrapes.

Mman said:
Correct. The brokers always make money. Sometimes they throw a bone to some of their preferred customers and let them in on some of the profit. It's the suckers that buy on the open market the first day that usually lose.
Click to expand...

Exactly why I didn't buy it. My main investment (VOO) which is vanguards s&p 500 ETF will eventually allocate it into its portfolio. I guess I'll get a piece of it then.
 
sevoflurane said:
Too late... I'm in 50K pre- IPO. My ortho buddy bought 200K pre-IPO. We will see how things go. I'm hoping it won't be a facebook flop... I doubt it tho. Picked up yahoo about a month ago. That was a good move. ;)

Wish me luck tomorrow.

:luck:
Click to expand...

Nice move man! I always thought the pre-IPO deals were only available to the multi-million dollar investor. (i figure if that was you, then you would have quit your day job by now)
 
sleepallday said:
Nice move man! I always thought the pre-IPO deals were only available to the multi-million dollar investor. (i figure if that was you, then you would have quit your day job by now)
Click to expand...


Quit your day job?? if you have less than $10 million in assets (that means after subtracting all your debt) then you are WEALTHY but not rich. Hence, most won't be quiting their day jobs until after age 60.

Money is purely subjective but if being rich means owning a yacht and/or private airplane, waterfront homes and a few high end cars (over $100K each) I doubt anyone on this board qualifies....yet.
 
BLADEMDA said:
Quit your day job?? if you have less than $10 million in assets (that means after subtracting all your debt) then you are WEALTHY but not rich. Hence, most won't be quiting their day jobs until after age 60.

Money is purely subjective but if being rich means owning a yacht and/or private airplane, waterfront homes and a few high end cars (over $100K each) I doubt anyone on this board qualifies....yet.
Click to expand...

I completely agree. By multi-million dollar investors, I meant upwards of $50-100 million.
 
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