Pacira Pharmaceuticals recently introduced EXPAREL, a bupivacaine liposome injectable suspension, for postoperative pain relief. Spine surgeons across the country have been experiencing success with EXAREL for a variety of spinal procedures, reporting pain relief for up to 72 hours.
Peter Whang, MD, FACS, an Associate Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine in New Haven, Conn., discusses the advantages he's seen and trends in postoperative pain management in the future for patients undergoing spinal procedures.
Q: What are the traditional methods surgeons use to manage spine patient pain postoperatively? What are the challenges for postoperative pain management?
Dr. Peter Whang: It's not unexpected for patients to have pain after spinal procedures so postoperative pain control is a major issue for spine patients and surgeons alike. There are local anesthetics we can administer but these are limited by their duration of effect; similarly, we can administer oral or intravenous medications but many of them may be sedating and give rise to other serious side effects. As a result, patients may experience increased morbidity and be at risk for any number of complications such as falls, ileus, or aspiration pneumonia, all of which can translate into longer hospital stays.
Q: What are the benefits of using liposomal bupivacaine in spinal procedures?
PW: I believe that EXPAREL has the opportunity to make a difference in terms of how we treat postoperative pain. This is a unique drug delivery system that allows us to release bupivacaine in a more controlled fashion. We can administer the bupivacaine immediately postoperatively and can expect pain relief for up to 72 hours.
There is data showing the use of this mediation may be associated with a number of advantages: less narcotic use, quicker mobility, and shorter hospital stays. As we focus on less invasive surgical techniques with the goal being to minimize postoperative pain and facilitate a quick recovery, this drug may allow us to turn an inpatient procedure into one that may be performed in an outpatient setting where patients don't need treatment with narcotics postoperatively.
Q: In what situations is liposomal bupivacaine ideal?
PW: It's ideal for both traditional inpatient as well as outpatient surgeries. It's the same medication we commonly use for our surgeries which is just delivered in a different fashion. Moreover, I believe that the use of EXPAREL may also have economic benefits which is certainly important in this era of limited health care resources.
Q: How is EXPAREL administered? Is it easy for spine surgeons to incorporate into their practices?
PW: At the completion of the procedure, EXPAREL is injected within the muscles and soft tissues in close proximity to the surgical wound. While it's relatively easy to administer, it is certainly important for surgeons to learn the proper technique in order to maximize its safety and efficacy. Bupivacaine is commonly used as a local anesthetic – it's the same medication but the difference is that it is packaged in liposomes in order to provide controlled, long-term pain relief.
Q: Data is important in today's evidence-based healthcare world. What support does EXPAREL have behind it?
PW: EXPAREL is already FDA approved and there have been clinical studies published with excellent results for a number of different applications including spinal procedures. In addition to extensive clinical experience, there is also good evidence establishing the safety and efficacy of EXPAREL as surgeons consider incorporating the use of this agent into their own practices.
Q: Cost is another huge factor in healthcare decision-making. Is this cost-effective?
PW: There is obviously a cost associated with EXPAREL, but I believe that it is more than made up for in other ways, such as decreased narcotic use and shorter hospital stays. In this changing healthcare climate, we all have to be cognizant of cost-effectiveness of everything we do. Aside from the improvements in postoperative pain control, one of the biggest advantages of EXPAREL is it potential to bring about significant cost savings for a wide range of spinal procedures.
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