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L E T T E R S & E - M A I L
Does Exparel Work Any Better Than Bupivacaine?
w Re: "Which Drug is Better for Post-op
Pain Control?" (July Manager's Guide to
Ambulatory Anesthesia, osmag.net/hBpEP3).
I was disappointed to read your article,
which seemingly set out to objectively eval-
uate the value of Exparel based on a thor-
ough review of available clinical data. The
article's central premise is that the value of
Exparel is derived from its ability to provide
"better pain control" than standard bupiva-
caine. This narrow interpretation leaves out
a crucial and measurable benefit associated with Exparel, one that has
broad-ranging implications for patient care and healthcare costs: opioid
minimization. The ability to reduce the consumption of opioids has
been shown to trigger a cascade of value-driving outcomes: lower rates
of opioid-related adverse events and complications, faster recovery,
shorter hospital length of stay, lower costs of care, and improved
patient satisfaction and quality of recovery after surgery. The impact of
Exparel on opioid consumption has been well-documented in
literature,
1-3
but was overlooked in the article in favor of a simple and
one-dimensional measure: pain scores.
Pain, and hence pain scores, are highly subjective in nature, and
while they must be a part of the equation when evaluating a new pain
modality, they cannot be the only endpoint reviewed. In our institu-
tion, we've evaluated the impact of Exparel across surgical proce-
dures, with research presented at the Society of Critical Care
Medicine
4
and accepted at this year's American College of Surgeons
meeting demonstrating a reduction in opioids in both orthopedic and
Ambulatory Anesthesia
July
2015
Manager's Guide to
Supplement to
What we found may surprise you. p. 2
Better Pain Relief ?
Which One Provides
The
revolution in
post-op pain control p. 7
6
things MH experts want
you to know p. 12
Does
your anesthesia
service make the grade? p. 37
S
