Exparel for ISB

[turnupthevapor]

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The Exparel rep is telling me Motor block lasts 24, Sensory (not to be confused with pain) at 36 and Analgesia for 72-96. I am going to try it for the first time next week. Just curious is this everyones experience? I would love to not place and follow another IS catheter and welcome this possibility.

Was planning on 10 of Exparel and 5 cc of 0.5% bupi? I also heard you have to paint the T/T of the plexus as it doesn't diffuse well. Any tips?

Thank you

 

[DrZzZz]

We've been using about 15cc of 0.5% bupi with 10cc Exparel. The image doesn't get overly degraded from the Exparel. Some mix it, some do the bupi followed by exparel. Doesn't seem to make much difference. Blocks are nowhere near as dense as when we were just using higher volumes of bupi without exparel, but there's some prolonged analgesic effect. Surgeons seem to like it because there's less complaints (supposedly) while the patients are on the floor, even though we're getting more calls from PACU about pain. Or maybe they're just getting their pockets lined from the reps...

 

[jwk]

For my n=1 on myself...

Right shoulder arthroscopy done 3 years ago with ISB with catheter and OnQ pump. Had to turn down the rate the evening of surgery due to ongoing phrenic involvement. Just decreasing 1cc/hr was enough to clear the phrenic. Coasted the next 3 days and took the catheter out after my AA recert exam that I had to schedule 6 months in advance.

Left shoulder arthroscopy 6 months ago with single-shot ISB with Exparel/bupi. Motor block not totally gone for 30 hours, and phrenic lasted into POD 2, which is somewhat irritating. Great pain relief >72 hours.

Because of my personal experience and getting phrenic dinged with both techniques, I'd rather have the catheter with the ability to control my dosing for my inevitable TSRs at some point in the future.

 

[anes121508]

10 exp + 10 bupy mixed, depositing in the sheath. 50-72 hrs of analgesia is what we are seeing

 

[Noyac]

I was under the impression that you should not mix local with exparel.

 

[ethilo]

The packaging days you can mix up to a certain amount but too much dilution with saline or other local can disrupt the liposomes.

 

[zizzer]

We generally mix 40-60mL of 0.25% bupi with Exparel for our bilateral TAPs. I thought it was just ropi that was supposed to be avoided with it.

 

[VaporMD]

https://www.exparel.com/sites/default/files/PP-EX-US-4273_Nerve_Block-Anesthesia_Dosing_Guide_Nov_2018.PDF

 

[VaporMD]

I use 10ml of exparel mixed with 10ml of 0.5% plain bupi- and give IV decadron 8mg. I have heard exparel compared to “Velcro” in that is stays where you put it (doesn’t diffuse much like standard locals do). My n=30ish and have been pleasantly surprised with about 24h motor and 48-72h sensory block

 

[sevoflurane]

Also been using it for TSA’s.

I’ve never had 72 hours, but 48+ isn’t uncommon.

133 mg of exparel + 10ccs of .25% bupi mixed in a 20cc syringe.

 

[vector2]

Does ropi release too much bupi from the liposomes when ropi and exparel are mixed?

 

[caligas]

Any pearls? Doesn’t it obscure your US view when you start injecting?

 

[okayplayer]

Any pearls? Doesn’t it obscure your US view when you start injecting?

No. Basically looks like any LA. The liposomes are pretty subtle.

 

[fakin' the funk]

You can mix normal bupivacaine with Exparel per the manufacturer as long as the Exparel (3
150 or 300mg) is more than 2/3 of all the bupivacaine.