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based assessment of its value to patients and the healthcare system.
Brian Faley, PharmD, BCPS
Ernest Mario School of Pharmacy at Rutgers University
Piscataway Township, N.J.
bfaley@hackensackumc.org
L E T T E R S & E - M A I L
References:
1. Dasta J, Ramamoorthy S, Patou G, Sinatra R. Bupivacaine liposome injectable suspension
reduces opioid burden compared with bupivacaine HCl in the postsurgical setting. CMRO 2012
September (online).
2. Cohen S, Vogel J, Marcet J, Candiotti K. J Pain Research. 2014;7: 359–366.
3. Batdorf N, Lemaine V, Lovel J, et al. Journal of Plastic, Reconstructive & Aesthetic Surgery.
2015;68(3):395-402.
4. Kaplan J, Faley B, Thomas Z, Chang T, Levine H, Klein G. Evaluation of liposomal bupivacaine for
pain management after total knee arthroplasty. [Abstract #629] Society of Critical Care Medicine 1/15.
5. Haas E, Onel E, Miller H, Ragupathi M, White P. American Surgeon. 2012;78:574-581.
w Outpatient Surgery Magazine responds: We thank Dr. Faley for his comments. We
agree with Dr. Faley that pain is notoriously difficult to study, and we agree that per-
sonal clinical experience is an important aspect of evaluating medications. We
respectfully disagree with the remainder of his points.
Dr. Faley says, "The impact of Exparel on opioid consumption has been well-document-
ed in literature," citing 3 studies. We find no convincing support for that statement in the
studies he cites.
In the first study, a Pacira employee and Pacira consultants aggregated the results of 9
small Pacira clinical trials into one large patient group. They found that Exparel patients
took 1 to 2 fewer 5 mg Percocets over a 3-day post-op period. Weak as those results are,
even they are in question, because the authors appear to have included data from 2 place-
bo-controlled studies in addition to the studies with active controls, potentially making the
data look better than they actually are.
The second and third studies suggest that Exparel may help to reduce opioid consump-
tion, but fail to address whether bupivacaine in the exact same dosage would have pro-
