he says. "Patients come in post-op Day 1 and
say they have no pain. They ask whether I actu-
ally did anything."
Patients, that is, who had surgery at the
Premier Surgical Center of Michigan, where Dr.
Bishai is able to use Exparel.
"I would love to use it at the hospital, too," he
says, "but certain hospitals have taken it off for-
mulary. I'm fighting with them, because I think
we should be worried about what's making
patients better, not about costs."
Exparel typically adds about $300 per case,
but that shouldn't be the point, Dr. Bishai
insists. "I have to scratch my head and say that
when we start worrying about cost superseding
patient care, that's the epidemic," he says.
Dr. Bishai says his staff can easily identify his
Exparel patients.
"A traditional interscalene block is going to
use something like Marcaine (bupivacaine
hydrochloride), which usually lasts about 18
hours, at most," he says. But Exparel's liposomes dissolve at different
rates over time, so the relief can last for days.
"The short-acting agent is working right out of the gate, and by the
time the Marcaine starts to wear off, the bupivacaine that's in the lipo-
somes is starting to release, thereby taking the patient 3 or 4 days out.
That's usually where you'd have the worst pain."
Just make sure it's administered correctly. "When you put those tiny
liposomal (fat) globules in, they don't move that well," says Dr. Bishai.
"If you don't move the needle around when you're putting it in, you're
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