New non opioid pain medication

[DYK343]

FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain

The FDA approved Journavx (suzetrigine) 50 mg oral tablets, a first-in-class non-opioid analgesic to treat moderate to severe acute pain in adults.

www.fda.gov

Interesting. Ive got a heavy drug seeking population. Possibly eliminate opioids in future.
Whats better is its was studied with bunionectomies. Should make getting it approved easier for us.

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[heybrother]

Did you try Zynrelef? It was also developed for bunions. It was a meloxicam/bupivicaine extended-release solution.

 

[DYK343]

Did you try Zynrelef? It was also developed for bunions. It was a meloxicam/bupivicaine extended-release solution.

Never heard of it.

 

[heybrother]

Never heard of it.

I had a rep come by to tell me about it. Haven't heard anything in awhile. Nuzyra rep is constantly coming by though.

 

[DYK343]

I had a rep come by to tell me about it. Haven't heard anything in awhile. Nuzyra rep is constantly coming by though.

They have come out with a lot of antibiotics over the last 5ish years and im really not up to date with them.

I work very closely with (AKA dump on) ID for inpatient.

Outpatient is either getting admitted for long term antibiotics or regular doxycycline is gonna be just fine.

My last job the ID doc was using Dalbavancin once weekly. But I was told it lost significant money for the facility every time it was prescribed.

 

[DYK343]

Exparel/Liposomal bupivicaine didnt work for my patients pop blocks. No difference.
Ive never tried it as local in the foot. But popliteal blocks didnt work.

 

[heybrother]

Exparel/Liposomal bupivicaine didnt work for my patients pop blocks. No difference.
Ive never tried it as local in the foot. But popliteal blocks didnt work.

I've never used Exparel. Zynrelef or however its spelled is not actually an injection if I understand correctly. Its deposited in the surgery site itself as opposed to say proximally around the ankle. The companies claim is the Meloxicam blocks the inflammation/pH change that nullifies the behavior of the anesthetic. I can't say. I haven't used it ever.

 

[DYK343]

I dont think Exparel is actually approved for popliteal blocks. So maybe thats why its didnt work better than plain bupivicaine. We had an anesthesiologist who wanted to use it on everyone. I didnt see any difference. 12-24hrs max.

 

[dtrack22]

Exparel/Liposomal bupivicaine didnt work for my patients pop blocks. No difference.
Ive never tried it as local in the foot. But popliteal blocks didnt work.

I get around 24 hours of post-op pain relief with local blocks using exparel and marine w epi (1:1 mixture). Have had patients tell me they didn’t have pain for 2 days, but just as many say they had pain 5-6 hours after surgery. On average it does seem to give significantly prolonged post-op analgesia when used as a local block in the foot.

I work at a critical access facility, however, so I get absolutely zero pushback on its cost. Something to consider as it is (supposedly) expensive. I wouldn’t know lol

 

[air bud]

I've never used Exparel. Zynrelef or however its spelled is not actually an injection if I understand correctly. Its deposited in the surgery site itself as opposed to say proximally around the ankle. The companies claim is the Meloxicam blocks the inflammation/pH change that nullifies the behavior of the anesthetic. I can't say. I haven't used it ever.

I have an attending who consulted for them and he said it worked....

 

[Bluecollarmed]

Have had patients tell me they didn’t have pain for 2 gays,

Where you giving this injection again? asking for a friend

 

[Bluecollarmed]

On a related note, I have friends in fellowship who use zynrelef and anecdotally relate good pain relief postoperatively

 

[dtrack22]

Were you giving this injection again? asking for a friend

Just a bit proximal to the ankle…

 

[GreenHousePub]

On a related note, I have friends in fellowship who use zynrelef and anecdotally relate good pain relief postoperatively

Well if a fellow-ship trained foot and ankle surgeon is using it, it must be good.

 

[wakaflocka88]

Not using tourniquet has been a game changer for me. If I need hemostasis for rear foot stuff during a case, I do a calf esmarch.

I also use gel foam soaked in thrombin often too if there’s constant oozing.

Pre and post incision marcaine plain 0.25%, didn’t notice any difference with Exparel as is and mixed.

I have my patients take ibuprofen 800mg TID one week straight post op.

I’m in the camp that some post op pain is a good thing, reminds them to be careful.

 

[Weirdy]

Not using tourniquet has been a game changer for me. If I need hemostasis for rear foot stuff during a case, I do a calf esmarch.

I also use gel foam soaked in thrombin often too if there’s constant oozing.

Pre and post incision marcaine plain 0.25%, didn’t notice any difference with Exparel as is and mixed.

I have my patients take ibuprofen 800mg TID one week straight post op.

I’m in the camp that some post op pain is a good thing, reminds them to be careful.

Was constantly trained to use tourniquet.
Would like to start not using tourniquet but old habits die hard.

 

[wakaflocka88]

Was constantly trained to use tourniquet.
Would like to start not using tourniquet but old habits die hard.

Try a calf esmarch before incision, don’t need to strangle the foot.

Lidocaine/marcaine with epi. Go to town using bovie for dissection.

 

[Homo sapien]

Was constantly trained to use tourniquet.
Would like to start not using tourniquet but old habits die hard.

I'd like to also

Do you just do procedures raw with cautery

 

[wakaflocka88]

I'd like to also

Do you just do procedures raw with cautery

Yes almost always use bovie to open subQ, capsule, periosteum, etc. Much cleaner too

 

[deleted1162946]

Just use a tourniquet and then let it down when you close…

 

[Flip-flop-flerpity]

Did you try Zynrelef? It was also developed for bunions. It was a meloxicam/bupivicaine extended-release solution.

Works pretty well except it handles like honey and makes everything super sticky during closure

 

[diabeticfootdr]

FDA Approves Novel Non-Opioid Treatment for Moderate to Severe Acute Pain

The FDA approved Journavx (suzetrigine) 50 mg oral tablets, a first-in-class non-opioid analgesic to treat moderate to severe acute pain in adults.

www.fda.gov

Interesting. Ive got a heavy drug seeking population. Possibly eliminate opioids in future.
Whats better is its was studied with bunionectomies. Should make getting it approved easier for us.

Interesting ... their FDA approval trial doesn't seem to be published??

 

[DYK343]

Interesting ... their FDA approval trial doesn't seem to be published??

Not sure. But I find this promising for my practice. Im tired of opioids.

I actually learned about this from a patient. Asked me if I heard the new knews about the "opioid killer" and I looked it up.