Brandon Winchester, MD, the regional anesthesia fellowship director
at the Andrews Institute for Orthopedics & Sports Medicine in Gulf
Breeze, Fla., gets pumped when he talks about managing post-op pain
with regional nerve blocks, continuous catheters and pain pumps. He
and his anesthesiology partner Gregory Hickman, MD, perform
around 2,500 blocks a year. They know regional anesthesia has exten-
sive benefits, including improved pain, decreased opioids, decreased
nausea, shorter PACU stays and greater patient satisfaction.
For outpatient surgeries involving mild to moderate post-operative
pain, such as wrist or ankle arthroscopies, a single-injection nerve
block with bupivacaine or ropivacaine plus preservative-free dexam-
ethasone will last 24 hours or longer. Patients usually are pain-free
long enough to get back home and sleeping through the night the day
of surgery and may start hitting functional milestones once they start
PT, says Dr. Winchester.
For moderate to severely painful outpatient surgeries — total
shoulder replacements, rotator cuff repairs, ACL reconstructions,
knee replacements and ankle fusions — patients receive a continu-
ous nerve catheter and disposable local anesthesia pain pump to
provide 4 or more days of "excellent pain relief" with minimal to no
opioid use, says Dr. Winchester. If their pain intensifies, patients
can press the pump bolus button for a boost of local anesthetic.
An expanded use for Exparel
Rotator cuff surgery has about a 10% incidence of opioid reliance over
time, studies show. That's why Dr. Sigman was so delighted when the
FDA gave the green light last April to an expanded use for Exparel,
which lets doctors use bupivacaine liposome as a regional interscalene
brachial plexus block. That makes Exparel the first long-acting, single-
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