By: Dr. Armen Voskeridjian, Anesthesiologist in Philadelphia, Pa.
As a physician and anesthesiologist focused on outpatient orthopedic surgery, I am always looking to improve pain management techniques to provide longer-lasting comfort for my patients before, during, and after surgery. Today’s most innovative solutions include non-opioid options. This involves implementing effective ways to manage pain throughout the surgical experience.
Over the last two decades, U.S. opioid prescribing has escalated. Orthopedic surgery was the fourth leading specialty in the number of prescribed opioids and the largest among surgical specialties. Some of the most painful surgeries we perform involve the shoulder, arm, knee, and foot/ankle. For many patients, and especially younger ones, their first exposure to opioids occurs because of a sports-related injury leading to orthopedic surgery.
Opioid abuse and overdose are a severe public health crisis in Pennsylvania and our nation. Although opioids are a useful adjunct in controlling pain, they do not need to be the frontline therapy. Opioids should be used only for severe to excruciating pain. They are also associated with many unpleasant side effects, including respiratory depression, nausea/vomiting, significant constipation, confusion, dizziness, and of course, addiction. As the Director of Anesthesia Services at my practice, I have combined my research, passion, and experience with these issues to educate my patients about non-opioid options.
Incorporating non-opioids into practice
At the Jefferson Surgical Center at The Navy Yard, we have incorporated a non-opioid option called EXPAREL® (liposomal bupivacaine injectable suspension) into our pain management protocol. EXPAREL is a specially formulated long-acting local anesthetic that we inject during surgery to help alleviate pain after surgery. Once injected, EXPAREL releases local anesthetic — a numbing medication — very slowly, providing pain relief for the first few days after surgery.
Our patients needed a pain management tool that could provide extended relief, but I found that the traditional approach (which involved placing a thin catheter near the nerves) presented its own challenges and difficulties. Luckily, the use of EXPAREL eliminates the need for a catheter, which has now become obsolete in my practice. We routinely see how EXPAREL provides our patients with several days of pain relief while reducing or eliminating the need for opioids.
Incorporating EXPAREL into our pain management protocol as well as other non-opioid options — like intravenous acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs — has benefited our patients’ overall recovery and revolutionized pain management for outpatient orthopedic surgery at the Jefferson Surgical Center at The Navy Yard.
In my practice specifically, I have seen that following ACL surgeries, 30-40% of patients require no opioids whatsoever. For shoulder and foot/ankle surgeries, the need for opioid use post-operatively has been nearly eliminated. That means most of these patients, many of whom are young, may experience zero exposure to narcotics. We’re also noticing that patients are getting up and moving earlier after surgery, tolerating rehab sooner, and experiencing less pain during rehab.
With the introduction of EXPAREL, we have observed a remarkable improvement in patient outcomes and overall recoveries. This innovative option has significantly transformed pain management by not only offering effective relief but also by reducing or eliminating the need for opioids. The success of EXPAREL in facilitating faster recovery offers a promising case for the widespread adoption of other non-opioid protocols, ushering in a new era of safer, less painful, and more efficient patient care. I am proud to say that our patients’ overall post-surgical experience has been vastly improved.
Advocating for alternative solutions
An alternative like EXPAREL has created a paradigm shift in how I can provide better care for my patients while also minimizing or even eliminating the need for opioids. As a physician, I feel a responsibility to educate my patients on the non-opioid pain management options available. I encourage healthcare providers and their patients to have informed conversations about non-opioid options prior to surgery. It’s important to develop a pain management plan that not only meets but exceeds recovery expectations — and improves the patient’s overall safety and surgical experience.
For more information, please visit www.EXPAREL.com/safety.
EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.
Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
FOR MORE INFORMATION, PLEASE VISIT www.EXPAREL.com or CALL 1-855-793-9727. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.