William Tally, MD, gave a presentation at the 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference, titled "Extended release liposomal bupivacaine: safety and efficacy for spinal procedures in an ASC setting."
Dr. Tally begins his presentation by explaining the increasing trend to treat patients in ambulatory centers. "For clarity of communication, we are not just moving to outpatient," Dr. Tally said. "We are moving to ambulatory centers, which is a substantial difference."
Two key factors driving patients to ASCs are cost and patient demand. Physicians like Dr. Tally are utilizing ASCs to minimize additional resources utilization that would drive up costs in hospitals.
While outpatient facilities are convenient and cost-effective, patients need to practice efficacy because the follow-up care is placed on the patients themselves. Pain management is a vital factor in determining patient satisfaction. Because outpatient facilities discharge patients the same day they undergo surgery, physicians need to have a conversation with their patients about what to expect post-op. "We have to talk to patients preoperatively," Dr. Tally explained. "We have to make sure they won't go home miserable." He is conducting an ongoing study on the use of extended-release liposomal bupivacaine. He measures the effectiveness of this medication in terms of patient safety and efficacy.
The TJA gives physicians guidelines on procedures in the multimodal analgesia, which Dr. Tally explains starts on the preoperative level. Dr. Tally tells patients "what they are going to feel, what to expect and what [his] expectations of them are." Dr. Tally has been using extended-release liposomal bupivacaine in an effort to extend the effect of a local anesthetic. The drug differs from others because its dosage is not weight dependent. Rather, the drug's duration depends on where the dosage is injected. "The drug itself depends on blood flow, how much you spread it out, how much scar tissue is present," Dr. Tally explained to attendees. One of the procedures utilizing extended -release liposomal bipuvacine is TLIF, a procedure on the rise.
Dr. Tally tested the drug in procedures determining patient safety and efficacy to ensure surgical centers have ample resources to perform procedures like TLIFs. Of the 46 patients in the study, 36 underwent TLIF procedures with an average operative time of 4.5 hours. Dr. Tally explained there were no complications and everybody was capable of walking out post-op.
Pertaining to the efficacy study, medical students did the majority of the work with results being preliminary. Patients were given Hydrocodone, Flerexil and Oxycodone and patients were called each day by medical students to make sure they were taking the correct dosage of medication. In the control group, patients had difficulty mobilizing whereas only two of the patients injected with EXPAREL had a complaint. The main complaint with minimally invasive TLIF was the spasms. Dr. Tally said he and his team will "continue to look to find a way to quantify them. It will be significant for patient satisfaction."
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