about it, roughly 500
are pro and 500 are
con.
Here's my view: I
think of it as more a
medical device than
a pharmacologic
process. In other
words, you have to
use it the right way
or you won't get the
results and outcomes you want.
What's the wrong way? The first mistake surgeons make with
Exparel is not using enough. You have to infuse the entire surgical
area, or the liposomes won't reach all the nerves that have been
injured. The second mistake they make is not putting it in all the right
places. For example, with total knee replacements, you absolutely
have to inject the posterior capsule. In many of the "con" papers I've
seen, the researchers failed to do that. If you inject it everywhere else
but miss the posterior capsule, you might as well not bother, because
the posterior capsule is really going to hurt.
The point is, there are about 5 million liposomes in a 20-cc vial, but
they don't know where to go; they only know what to do. They'll only
work if you put them into all the right places. You have to mix the
medication to a volume that lets you get to where you need to go.
Admittedly, the company that markets liposomal bupivacaine
(Pacira Pharmaceuticals) is partly to blame for some of the early fail-
ures. They were a new company with one product, and, in retrospect,
they could have done a better job of conveying a clear message and
clear instructions.
3 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
• PRECISION PLACEMENT You have to use Exparel (liposomal bupivacaine) the right
way or you won't get the results and outcomes you want.
Scott
A.
Sigman,
MD
