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Kristy Bultema, Sara Fowler, Melissa Drum, Al Reader, John Nusstein, Mike Beck
INTRODUCTION: In the treatment of patients with symptomatic irreversible pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively...
October 18, 2016: Journal of Endodontics
Krishna S Vyas, Sibi Rajendran, Shane D Morrison, Afaaf Shakir, Samir Mardini, Valerie Lemaine, Maurice Y Nahabedian, Stephen B Baker, Brian D Rinker, Henry C Vasconez
BACKGROUND: Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system...
October 2016: Plastic and Reconstructive Surgery
Brandon Glenn, Melissa Drum, Al Reader, Sara Fowler, John Nusstein, Mike Beck
INTRODUCTION: Medical studies have shown some potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA), a slow-release bupivacaine solution, to extend postoperative benefits of numbness/pain relief for up to several days. Because the Food and Drug Administration has approved Exparel only for infiltrations, we wanted to evaluate if it would be effective as an infiltration to control postoperative pain. The purpose of this study was to compare an infiltration of bupivacaine with liposomal bupivacaine for postoperative numbness and pain in symptomatic patients diagnosed with pulpal necrosis experiencing moderate to severe preoperative pain...
September 2016: Journal of Endodontics
Constantinos Ketonis, Nayoung Kim, Frederic Liss, Benjamin Zmistowski, Jonas Matzon, Charles Leinberry, Mark Wang, Christopher Jones, Jack Abboudi, William Kirkpatrick, Asif M Ilyas
BACKGROUND: Local anesthetics are routinely used in hand surgery for procedures such as trigger finger releases (TFRs). However, little is known as to the difference in efficacy and patient experience with various local anesthetics. We prospectively evaluated the efficacy of Lidocaine (L), Marcaine (M), and Exparel (E) to elucidate differences in pain scores and opioid consumption between these groups. METHODS: All consecutive TFR performed over a 6-month period in 2014 at our institution were divided to receive Lidocaine, Marcaine, or Marcaine with postoperative Exparel...
June 2016: Hand: Official Journal of the American Association for Hand Surgery
C S Kirkness, C V Asche, J Ren, K Gordon, P Maurer, B Maurer, B T Maurer
OBJECTIVE: Perioperative pain management is an important aspect of recovery from total knee arthroplasty (TKA) because severe pain can delay ambulation and hospital discharge. The objective of this retrospective sequential cohort study was to determine the impact of local infiltration analgesia using liposome bupivacaine (Exparel (1) ) when compared with a continuous femoral nerve block (FNB) following TKA. METHODS: This retrospective cohort study included consecutive patients who underwent TKA between April 2011 and April 2014, and received one of three interventions...
July 18, 2016: Current Medical Research and Opinion
José Raul Soberón, Leslie E Sisco-Wise, Ross M Dunbar
Acute compartment syndrome is a condition that may result in sensorimotor deficits and loss of function of the affected limb as a result of ischemic injury. It is considered a surgical emergency and prompt diagnosis and treatment results in more favorable outcomes. The use of regional anesthesia is controversial in patients at risk for compartment syndrome due to concern of its potential to mask symptoms of the condition. A 44-year-old African American male presented to surgery for open reduction and internal fixation of a comminuted distal radius fracture...
June 2016: Journal of Clinical Anesthesia
Ajay Premkumar, Heather Samady, Harris Slone, Regina Hash, Spero Karas, John Xerogeanes
BACKGROUND: Local anesthetics are commonly administered into surgical sites as a part of multimodal pain control regimens. Liposomal bupivacaine is a novel formulation of bupivacaine designed for slow diffusion of a single dose of local anesthetic over a 72-hour period. While early results are promising in various settings, no studies have compared pain management regimens containing liposomal bupivacaine to traditional regimens in patients undergoing anterior cruciate ligament (ACL) reconstruction...
July 2016: American Journal of Sports Medicine
Roger H Emerson, John W Barrington, Oluseun Olugbode, Scott Lovald, Heather Watson, Kevin Ong
Multimodal wound infiltration analgesic techniques have attracted growing interest for applications in total knee arthroplasty (TKA). A benefit of using wound infiltration instead of femoral nerve block (FNB) in a multimodal pain control regimen is the limitation of muscle strength impairment to the surgical area, which will focus the pain control effort and may provide the opportunity for easier rehabilitation and earlier discharge from the hospital. The current study directly compares patients undergoing TKA who are given a continuous FNB with those who were administered an injection of liposomal bupivacaine infiltration...
May 1, 2016: Orthopedics
Adam J Oppenheimer, Thomas G S Fiala, Daniel C Oppenheimer
BACKGROUND: Pain control following abdominoplasty is a major source of concern for the patient and surgeon alike. Pain pumps and opiate medications are currently the frontline therapies. With the following technique, Exparel (liposomal bupivacaine, 72-hour duration of action) has been used for transversus abdominis plane (TAP) blocks under direct visualization during abdominoplasty with the goal of improving pain control during the early and intermediate recovery period. MATERIALS AND METHODS: In this pilot study, 13 consecutive patients were treated with the direct, fascial-splitting technique to reach the TAP plane...
November 5, 2015: Annals of Plastic Surgery
Kamal G Khalil, Mina L Boutrous, Adel D Irani, Charles C Miller, Timothy R Pawelek, Anthony L Estrera, Hazim J Safi
BACKGROUND: Postthoracotomy pain is quite intense. Epidural analgesia (EPI) has long been the gold standard but is often associated with hypotension and urinary retention. The recent availability of liposomal bupivacaine formulation (Exparel) stimulated us to use it for multilevel intercostal nerve blocks (IB) injected during open thoracotomy. METHODS: We reviewed the records of 85 patients who had open thoracotomies for lung, pleural, or mediastinal pathologies between March 2010 and December 2013...
December 2015: Annals of Thoracic Surgery
Fred D Cushner
The efficacy of regional anesthesia and peripheral nerve blocks in the management of postoperative pain has resulted in widespread use of this approach in hip and knee arthroplasty. With extensive clinical use, however, the limitations of this approach have become apparent. These limitations include delays for the surgeon, inefficient use of the operating room, muscular weakness, and associated delays in physical therapy. Periarticular injection of anesthetic and analgesic medications appears to offer comparable benefits to nerve blocks in joint arthroplasty without these limitations...
October 2015: American Journal of Orthopedics
Robert E Booth
In the current health care environment, it is more important than ever for orthopedic surgeons to strive for optimal efficiency and effectiveness. For maximum efficiency, patients can be preselected to limit patient types that commonly require a greater investment of the practice's time and resources. Structuring surgical practices for efficiency may involve rethinking the staffing model, anticipating problems that may occur with individual patients, and enhancing internal and external communications. Turnover time between patients must be measured and minimized, and activity in the operating room--including the surgeon's own technique--must be evaluated and refined where necessary...
October 2015: American Journal of Orthopedics
Giles R Scuderi
Analgesic gaps--periods of inadequate pain control--commonly compromise the management of pain after joint arthroplasty. Such gaps can and should be prevented. The use of well-designed, balanced multimodal analgesic regimens that comprise a combination of agents working independently in both the peripheral and central nervous systems is an effective way to prevent gaps in pain control. Medications that have been shown to be beneficial as components of multimodal regimens include acetaminophen, cyclo-oxygenase 2 (COX-2) inhibitors, gabapentinoids, glucocorticoids, periarticular injections using agents such as bupivacaine HCl and bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc), and long-acting opioids...
October 2015: American Journal of Orthopedics
John W Barrington
Attention to patient satisfaction is critical in today's health care environment-satisfaction surveys inform the development of hospital performance standards and can influence an institution's rankings and reimbursement. The effectiveness of postoperative pain management can affect clinical outcomes and also influence the patient's perception of the overall surgical experience. Ample clinical- trial data now exist that demonstrate the benefits of periarticular injections as part of a multimodal regimen in patients undergoing joint arthroplasty...
October 2015: American Journal of Orthopedics
Mark Burbridge, Richard A Jaffe
No abstract text is available yet for this article.
October 2015: Anesthesia and Analgesia
Anna Uskova, Jessica E O'Connor
PURPOSE OF REVIEW: Using a regional block in a multimodal approach to postoperative analgesia management involves addressing, which local anesthetic and how much should be used to ensure adequate pain relief to reduce related morbidity and mortality. This article will review literature surrounding the recently approved formulation of slow release liposomal bupivacaine, define its proven benefits, and identify ongoing studies to further examine the utility of this novel formulation by various routes...
October 2015: Current Opinion in Anaesthesiology
Brian M Ilfeld, Eugene R Viscusi, Admir Hadzic, Harold S Minkowitz, Michael D Morren, Janice Lookabaugh, Girish P Joshi
BACKGROUND: Liposome bupivacaine (Exparel) is a multivesicular liposomal formulation of bupivacaine currently approved in the United States for single-dose administration into the surgical site to provide postsurgical analgesia. This retrospective analysis examined safety data from clinical trials involving the off-label use of this formulation in peripheral nerve blocks. METHODS: Data from 6 controlled (phases I-III) studies were compiled involving single-injection ankle, femoral nerve, and intercostal nerve blocks (2 each)...
September 2015: Regional Anesthesia and Pain Medicine
Daniel R Butz, Deana S Shenaq, Veronica L M Rundell, Brittany Kepler, Eric Liederbach, Jeff Thiel, Catherine Pesce, Glenn S Murphy, Mark Sisco, Michael A Howard
BACKGROUND: Patients undergoing mastectomy and prosthetic breast reconstruction have significant acute postsurgical pain, routinely mandating inpatient hospitalization. Liposomal bupivacaine (LB) (Exparel; Pacira Pharmaceuticals, Inc., Parsippany, N.J.) has been shown to be a safe and effective pain reliever in the immediate postoperative period and may be advantageous for use in mastectomy and breast reconstruction patients. METHODS: Retrospective review of 90 immediate implant-based breast reconstruction patient charts was completed...
May 2015: Plastic and Reconstructive Surgery. Global Open
Bradley Stephan, Bruce Ramshaw, Brandie Forman
Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program...
May 2015: Surgical Technology International
Suzette G Miranda, Thomas Gallagher, Hakim K Said
No abstract text is available yet for this article.
May 2015: Plastic and Reconstructive Surgery
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