Post-operative analgesia is both necessary for patient comfort and satisfaction. Peripheral nerve block offer both good post-operative analgesia and patient satisfaction, but rarely cover the entire period of post-ope...Post-operative analgesia is both necessary for patient comfort and satisfaction. Peripheral nerve block offer both good post-operative analgesia and patient satisfaction, but rarely cover the entire period of post-operative pain. Nonnarcotic drugs are extremely helpful, but with severe pain, narcotics are usually used to help with post-operative pain when the nerve block wears off. However, nausea and vomiting, as well as other side effects associated with narcotic use can be severe and limit their use for post-operative analgesia. The addition of supplements to the local anesthetic used for the nerve blocks can extend the analgesia, but few blocks last greater than 24 hours. We describe the use of a relatively new extended release bupivacaine, Exparel that provide significantly longer analgesia than presently used single shot techniques protocols for extended nerve block analgesia.展开更多
Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, the...Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics.展开更多
Achieving adequate control of postsurgical pain remains a challenge in patients undergoing Total Knee Arthroplasty (TKA). The objective of this study was to assess if liposomal bupivacaine injected into the posterior ...Achieving adequate control of postsurgical pain remains a challenge in patients undergoing Total Knee Arthroplasty (TKA). The objective of this study was to assess if liposomal bupivacaine injected into the posterior capsule, in combination with a femoral nerve block and multimodal pain control regimen, would result in better pain control. The two groups were similar with regards to demographics and method of intraoperative anesthesia. Infiltration into the posterior capsule with liposomal bupivacaine had significantly lower resting pain scores compared to the saline group. Patients in the liposomal bupivacaine group also used slightly less breakthrough narcotic (5.75 to 4.31 mg of morphine equivalence). We recommend the use of infiltration of liposomal bupivacaine into the posterior capsule as an adjunct in multimodal analgesia in TKA patients to reduce pain and resultant narcotic use.展开更多
Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study inves...Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.展开更多
文摘Post-operative analgesia is both necessary for patient comfort and satisfaction. Peripheral nerve block offer both good post-operative analgesia and patient satisfaction, but rarely cover the entire period of post-operative pain. Nonnarcotic drugs are extremely helpful, but with severe pain, narcotics are usually used to help with post-operative pain when the nerve block wears off. However, nausea and vomiting, as well as other side effects associated with narcotic use can be severe and limit their use for post-operative analgesia. The addition of supplements to the local anesthetic used for the nerve blocks can extend the analgesia, but few blocks last greater than 24 hours. We describe the use of a relatively new extended release bupivacaine, Exparel that provide significantly longer analgesia than presently used single shot techniques protocols for extended nerve block analgesia.
文摘Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics.
文摘Achieving adequate control of postsurgical pain remains a challenge in patients undergoing Total Knee Arthroplasty (TKA). The objective of this study was to assess if liposomal bupivacaine injected into the posterior capsule, in combination with a femoral nerve block and multimodal pain control regimen, would result in better pain control. The two groups were similar with regards to demographics and method of intraoperative anesthesia. Infiltration into the posterior capsule with liposomal bupivacaine had significantly lower resting pain scores compared to the saline group. Patients in the liposomal bupivacaine group also used slightly less breakthrough narcotic (5.75 to 4.31 mg of morphine equivalence). We recommend the use of infiltration of liposomal bupivacaine into the posterior capsule as an adjunct in multimodal analgesia in TKA patients to reduce pain and resultant narcotic use.
文摘Transverse abdominis Plane blocks (TAP) provide effective postoperative analgesia following surgical incisions of the lower and middle abdominal wall, including those associated with cesarean section. This study investigated the efficacy of liposomal bupivacaine diluted with 0.25% bupivacaine administered in bilateral TAP blocks for post-operative analgesia after Ce-sarean section preformed under neuraxial anesthesia. The patients who received the TAP blocks with liposomal bupivacaine had noticeably low pain scores of 1.0 ± 1.4, 1.4 ± 2.1, 1.7 ± 1.9, 1.9 ± 3.3 and 1.9 ± 2.3 at 6, 12, 24, 48 and 72 hours respectively. Only 3 patients used oxycodone (5 mg)/acetaminophen (325 mg) postoperative. One patient took two tables of oxycodone (5 mg)/acetamino-phen (325 mg) after 24 hours, a second patient used oxycodone (5 mg)/aceta-minophen (325 mg) after 72 hours and the third patient was transferred to the intensive care unit (ICU) since she developed postpartum cardiac complications, and was give oxycodone (5 mg)/acetaminophen (325 mg) despite having a 0 pain score. These results suggest that patients treated bilateral TAP blocks with a mixture of liposomal and regular bupivacaine will have low pain scores, high patient satisfaction and reduce the use of postoperative narcotics.
