Still, 10% of respondents say they're sold on the benefits of Exparel.
Meanwhile, another 10% say they prefer to implant catheters and send
patients home with pain pumps.
Good news, bad news
Non-opioid intravenous analgesics are also popular choices for treat-
ing "routine post-operative pain," though a significant percentage of
respondents complain that they can be prohibitively expensive.
Among those willing to pay the price, IV-acetaminophen (Ofirmev)
is clearly the first choice (75.6%) among providers, though IV-ibupro-
fen (Caldolor, 19.5%) and IV-diclofenac (Dyloject, 9.8%) also have their
advocates.
"That's more really good news," says Dr. Viscusi.
But it's tempered with bad news. Seventeen percent of respondents,
mostly surgeons, say they also sometimes opt for extended-release
opioid products like OxyContin and fentanyl patches. "That scares
me," says Dr. Viscusi. "Extended-release opioids should not be used in
new and acute pain. It's against the label. The label changed in 2013
because using them in the perioperative scenario was linked to respi-
ratory deaths."
Difficult patients
Another concern for Dr. Viscusi: Nearly 35% of respondents say they
escalate opioid doses to account for tolerance when dealing with
patients who are taking chronic opioid therapy or who have histo-
ries of substance abuse. "That could increase the risk of respiratory
depression," he says. "I'd much rather see people use a multimodal
approach, use regional and try not to escalate opioid doses."
Ketamine is also a popular choice (46.9%) for this subset of patients,
as is deferring to the patient's regular prescriber (46.9%). Some
1 2 4 • 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 6
