"People are realizing that single-shot blocks don't do much good,
especially if you're trying to minimize opioid use," says Gregory
Hickman, MD, medical director and director of anesthesia at the
Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla.
He places CNBs in cases ranging from rotator cuff and labrum
repairs to total-knee replacements.
So what's the sweet spot for CNB usage? "We leave the block in for
4 days, and patients discontinue the use of the catheter on day 4,"
says Dr. Hickman. "We used to only do 3 days, but we noticed patients
had some pain on that fourth day."
2. Exparel
Long-lasting pain relief. Opioid-sparing. Single-dose infiltration. What's
not to like about Exparel (liposomal bupivacaine)? Administered direct-
ly at the incision site during surgery, Exparel provides up to 72 hours
of post-op pain relief, says Pacira Pharmaceuticals. Some say that
number could be on the high side.
"We've done our own internal study and found that Exparel can last
anywhere from 48 to 72 hours, but in most cases, it's closer to 48,"
says Dr. Hickman. "That means it wears off at an inopportune time for
recovering patients."
Plus, there's the commitment aspect. "You're essentially married to
Exparel until it wears off," says Nabil Elkassabany, MD, the director of
orthopedic anesthesia at the Hospital of the University of Pennsylvania
in Philadelphia. "But if, for example, you place an interscalene block
with a catheter and the patient complains of shortness of breath because
of phrenic nerve involvement, all you have to do is stop the infusion for
a few hours and the symptoms will resolve."
Few challenge Exparel's claim that it reduces the need for opioids.
Studies have shown that patients went longer before needing opioids
M A Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 6 3
