Exparel after Block

[GaseousClay]

Do you have a specific time frame you would wait before having surgeon give exparel into surgical area if block is done preop? For instance preop adductor with 30ml of 0.5% ropi and 2 hours later surgeon wants 266mg of exparel into surgical area. Do you say no due to toxicity? If so how long would you want to wait to give exparel if ok with giving at all?

 

[Hoya11]

Do you have a specific time frame you would wait before having surgeon give exparel into surgical area if block is done preop? For instance preop adductor with 30ml of 0.5% ropi and 2 hours later surgeon wants 266mg of exparel into surgical area. Do you say no due to toxicity? If so how long would you want to wait to give exparel if ok with giving at all?

30cc of 0.5% is OK with the full bottle of exparel. Its the max though. And technically it should be bupivicaine but probably no difference. We are talking about for patients > 70kg. No time frame, any time is OK.

 

[BLADEMDA]

Do you have a specific time frame you would wait before having surgeon give exparel into surgical area if block is done preop? For instance preop adductor with 30ml of 0.5% ropi and 2 hours later surgeon wants 266mg of exparel into surgical area. Do you say no due to toxicity? If so how long would you want to wait to give exparel if ok with giving at all?

my hunch is 3,000+ patients and still going who get an adductor canal block with local or Exparel along with LIA by the surgeon with more local/Exparel. We haven't seen a single case of local anesthetic toxicity even in the elderly population.

The guidelines are extremely conservative (it's how things are done in the USA) so this is a non-issue unless the patient is extremely low weight and elderly (under 50 kg). Then, I'd likely cut back the adductor canal block to 0.25% Rop with dexamethasone (20 mls).