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1 0 6 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 4 Aldrete scoring system. Such fast-tracking may be a lucrative move. In a 2004 study in the journal Anesthesiology, Dr. Williams and his co-authors calculated that regional anesthesia could save surgical facilities $800 per patient ("In late '90s dollars," he says, "which could only have gone up since then"): $400 through bypassing PACU and $400 through avoiding stan- dard hospital admission in cases which could have been done outpa- tient. "That may have been the spark that encouraged regional anesthesia among providers who weren't performing it already," he says. "You could finally go to administrators and say, 'This could pay for itself, and then some.'" Resources reconsidered The difference between the cost of drugs used for general anesthesia and those used in regional techniques is negligible, and outside of one exception (a nerve block administered expressly to manage post-op pain is separately billable), the two methods are reimbursed under the same code. However, anesthesia's use of resources, directly or indirectly, still plays a role. "Anything that reduces the time the patient spends in the facility is going to save the facility dollars," says Dr. Hudson, most notably in its nurse staffing. Awake, alert patients with less post-op pain and fewer side effects to treat, a shortened PACU stay and earlier discharges mean fewer nursing hours on the clock. "When people are out in under an hour, as opposed to 2-plus hours, you're saving a lot of money on your personnel costs," agrees Dr. Rosen. It's not just about staffing, though. "Often with regional anesthesia, you're utilizing fewer resources and consumables. As a result, depending on the procedure and depending on how you're reimbursed for things, A N E S T H E S I A THE TRUTH HURTS PACIRA'S CLAIM: EXPAREL ® provides patient-focused pain control for up to 72 hours. 3 THE FACTS: Based on further analysis of the data, 6 between 12–72 hours there was minimal to no difference in mean pain intensity between EXPAREL ® and saline (placebo). 4-5 PACIRA'S CLAIM: The only single-dose local analgesic to reduce or eliminate opioids with pain control for up to three days. 3 THE FACTS: The clinical benefi t of the attendant decrease in opioid consumption was not demonstrated. 2-3 Saline therapy (placebo) was favored between 12–72 hours. 5 Get the facts and download studies about EXPAREL ® at factvsfi ction.info or call 1-800-448-3569 for more information. The truth behind EXPAREL ® (bupivacaine liposome injectable suspension) 1 What is EXPAREL®, EXPAREL® Website. www.exparel.com/what-is-exparel.shtml. Created May 2, 2008. Updated December 16, 2013. Accessed February 4, 2014. 2 Exparel® [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011. 3 EXPAREL. Advertisement. Outpatient Surgery1 Nov. 2013:57-58. Print. 4 Golf M, Daniels SE, Onel E. A Phase III, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. Sep 2011;28(9):776-788. 5 Gorfi ne SR, Onel E, Patou G, et al. Bupivacaine Extended-Release Liposome Injection for Prolonged Postsurgical Analgesia in Patients Undergoing Hemorrhoidectomy: A Multicenter, Randomized, Double-blind, Placebo-controlled trial. Dis Colon Rectum. Dec. 2011;54(12):1552-1559. 6 Data on File. EXPAREL® is a registered trademark of Pacira Pharmaceuticals Inc. I-Flow*, LLC, A Kimberly-Clark Health Care Company. ON-Q* Pain Relief System *Registered trademark or trademark of Kimberly-Clark Worldwide Inc. © 2014 KCWW All rights reserved. RX Only. MK-00652 Effective post-op pain management. For over 3.5 million patients and counting. Controllable. Long-lasting. Proven. 6 Promotional claims position EXPAREL ® as the only single-dose local analgesic to reduce or eliminate opioids with pain control for up to three days with no need for catheters or pumps. 1-2 Sound too good to be true? It is. Every day without costs you more 6 A K I M B E R L Y - C L A R K H E A L T H C A R E C O M P A N Y OSE_1406_part2_Layout 1 6/13/14 11:41 AM Page 106