Outpatient Surgery Magazine

Manager's Guide to Surgery's Ambulatory Anesthesia - July 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5 W hen attempting to control post-operative pain, which drug is better — bupiva- caine, at a price of about $2.80 per vial, or the lipo- somal bupivacaine formulation trade-named Exparel, at about $285 per vial? For the price, Exparel should be lights-out better. But it's not clear if Pacira Pharmaceuticals' flagship pain medication is even slightly superior at control- ling post-op pain than conventional local anesthetics. An examination of Exparel's clinical trial data, the FDA's evaluation of those data and a patchwork of post-approval studies show very little difference between the performance of liposomal bupivacaine and standard bupivacaine. "And at $285 for a dose of Exparel versus $2.80 for a shot of bupivacaine, Which One Provides Better Pain Relief? Dan O'Connor Editor-in-Chief What we found may surprise you. Examining Exparel's Effectiveness It sounds like a great concept. Encapsulate bupivacaine in tiny bubbles made out of the same material as a cell membrane, and inject it into the muscles and soft tissues around the surgical wound. Like soap bubbles in a dishpan, these bubbles will burst slowly and predictably, releasing the pain-numbing medication over 72 hours for up to 3 days of pain control. No pumps, no catheters, no opioids. That's the promise of Exparel. Many studies, however, have found no signifi- cant benefit from using liposomal bupivacaine instead of standard bupivacaine in periarticular injec- tions as part of a multimodal pain management strategy.

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