What blocks are you using exparel for?

[Maz777]

But the whole argument for exparel is based off a comparison to catheters that last 36 or 48 or 72 hours. I personally find it puzzling that a number of folks that I respect have found exparel to work successfully while another number of folks that I respect have a vehement disregard for it.

And the truth is there are actually no randomized clinical trials out there showing that exparel doesn't work. Which is also quite puzzling, you'd think a busy academic center could just randomize patients to catheter vs exparel vs plain bupi and see what happens. Instead it's all intercostal nerve blocks and penile blocks that folks are publishing on, all techniques that are pretty irrelevant to our day to day and are traditionally blocks that are difficult to assess (intercostal).

I think you are confused. There are plenty of non-Pacira-funded/controlled RCTs showing no difference between Exparel and plain bupi.

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[Ronin786]

I think you are confused. There are plenty of non-Pacira-funded/controlled RCTs showing no difference between Exparel and plain bupi.

Which studies are you referring to? If you read the meta analysis that lead to the lawsuit, they included 9 studies. 4 of those were taken from clinicaltrials.gov and never actually published. And of the rest, only one was interscalene blocks (Addition of Liposome Bupivacaine to Bupivacaine HCl Versus Bupivacaine HCl Alone for Interscalene Brachial Plexus Block in Patients Having Major Shoulder Surgery - PubMed), the rest were intercostal, fascia iliaca or dorsal penile block.

 

[pocafx]

Catheter guys/gals: what are your protocols for who pulls the catheter and who gets called to troubleshoot postop? My partner gives out his personal cell and has patients pull the cath at home 72 hours post. All of that sounds horrifying to me so I’m pushing for Exparel approval asap. Surgeons don’t care which but want one or the other.

Residents if you have them. Education from ortho office visit and ortho nurses. Reiterate education Pre-op and pacu. Residents call each afternoon and on 3rd day . Patient pull cath at home while on the phone. We had very few/no serious problems. Getting pulled out or coming unattached most common.

 

[fakin' the funk]

Catheter guys/gals: what are your protocols for who pulls the catheter and who gets called to troubleshoot postop? My partner gives out his personal cell and has patients pull the cath at home 72 hours post. All of that sounds horrifying to me so I’m pushing for Exparel approval asap. Surgeons don’t care which but want one or the other.

The patients pull the catheters. We have a robust system where they call the pump mfr or the surgery dept before calling the anesthesia dept or on call anesthesiologist directly. (The most common question is "can I take my Percocet" YES OF COURSE) Thorough standardized discharge instructions and a post-op day 1 phone call. Occasionally a patient comes to the ED for a disconnected or dislodged catheter, which is a headache, but vast majority of the time these are smooth sailing.

I counsel patients that a catheter is more reliable and titratable, but more work; an Exparel block is not reliable, likely to be shorter, but zero work. Some folks lean strongly one way or another and some folks I "make" the decision for.