To combat the growing opioid crisis in America and manage the pain of his total joint replacement patients, Nirav Amin, MD, began using Exparel (bupivacaine liposome injectable suspension), with his surgical patients who qualify.
Surgeons inject Exparel at the surgical site during a procedure to cover the area in a blanketing fashion, and the medication releases bupivacaine over time to manage postsurgical pain. Besides being non-addicting, Exparel can decrease the average length of stay for patients and potentially allow patients to ambulate the day of surgery with considerably less pain. The long-acting anesthetic is designed to manage the patient's pain for up to 72 hours.
To Dr. Amin, who also serves as an associate professor at Loma Linda University Medical Center, using Exparel was an easy decision.
When he was first performing total joint replacement procedures his patients had lengths of stay around three to four days, and would experience severe pain throughout the rehabilitation process. The traditional means to treat that pain was through the use of opioids until a non-opiate would relieve that pain.
Opioids have an addictive quality, and can endanger a patient's well-being.
"A study shows there is a 6 to 8 percent rate where patients will seek out opioids from an outside source six to eight months after a surgery," Dr. Amin said.
Recent research further backs that point. A survey by Wakefield Research polled 500 adults who had undergone an orthopedic procedure within the last 12 months and surveyed 200 surgeons about their experience. The firm released the survey in August 2016.
Despite an 83 percent level of awareness of the dangers of opioid use, 10 percent of the surveyed patients reported becoming addicted to or dependent on opioids following surgery. When scaled to the 70 million surgeries performed annually, the findings suggest that nearly 7 million people could have some sort of opioid addiction or dependency.
Patients aren't the only ones feeling the pressure of opioid use. Physicians are too. In the survey, 94 percent of physicians felt pressured to prescribe opioids, and 91 percent of them often felt they needed to prescribe more than what was needed. More than half—70 percent of the physicians surveyed — reported patients frequently asked for specific opioids by name.
Opioid addiction wasn't a risk Dr. Amin wanted to take. He isn't alone either. In the Wakefield survey, 70 percent of surgeons reported they would prescribe a non-opioid treatment if they knew it could effectively manage patients’ pain.
For Dr. Amin, Exparel fills that desire. The drug allows him to reduce the amount of opioids he prescribes, and is allowing patients to return to their normal ways of life sooner.
When Exparel wears off, the patient is often able to manage pain with a lesser strength pain medication.
Another benefit of Exparel is better patient outcomes. By managing the pain, and allowing patients to recoup in their homes after a procedure, Dr. Amin has seen his patient satisfaction rate rise.
"The other reason I started to switch over was because patients were happier," Dr. Amin said. "They were surprised they were able to get up after having a total joint procedure."
Exparel is aligning him better with value-based initiatives, allowing patients to discharge 23 hours after their procedure because their pain is low and they're able to move around.
"There was a gap in pain medication, and patient satisfaction, and Exparel was the perfect bridge," Dr. Amin says. "It allows the patient to have a comfortable first few days at home or in the hospital after having a total joint procedure. That was almost unheard of."
Exparel has not been tested and is not recommended for epidurals, intrathecals, regional nerve blocks or intravascular or intra-articular use. It is also not recommended for patients younger than 18 years old or pregnant patients.
Exparel was evaluated in 10 randomized, double-blind, clinical studies. The drug was directly administered into the surgical site of 823 patients. The most common (equal to or greater than 10 percent) adverse reactions in those trials were nausea, constipation and vomiting.
The most severe reactions to the class of medications known as amide-type local anesthetics (which includes lidocaine, mepivacaine, prilocaine, ropivacaine, and bupivacaine—the active ingredient in Exparel), are experienced in the central nervous and cardiovascular systems. They are very rare, but they do occur.
"High plasma concentrations of bupivacaine can occur from overdosage, unintended intravascular injection, or accumulation of bupivacaine in plasma secondary to decreased hepatic metabolic degradation of the drug or diminished plasma protein binding capacity due to acidosis, pathologically lowered plasma protein production, or competition with other drugs for protein binding sites. Although rare, some individuals have a lower tolerance to and are supersensitive to bupivacaine and other amide-type local anesthetics and may rapidly develop signs of toxicity at low doses."
Click here to learn more about Exparel's use and adverse events.
More articles on improving performance:
Stryker courts ASCs with Ascential spine device, inventory management solution: 5 things to know
NJ Association of Ambulatory Surgery Centers sends members to Capitol Hill in support of access to care bills: 3 takeaways
Senior in home care start-up Hometeam names CMO: 4 takeaways