So this is out of a “Special Report” supplement to Anesthesiology News and General Surgery News. It focused on how “enhanced recovery protocols” are important for women healing from surgery. They specifically looked at surgical procedures on women, focusing on Csections, Gynecological surgery, and Breast surgery.
This was a mailer I received by the makers of Exparel, so I take this with a grain of salt. But they report some interesting things.
- 2018 retrospective review looking at patients who had an Exparel block after C section and those without. Findings:
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- Those with Exparel had significant reductions in post surgery opioid pain medication,
- significantly better pain control, and
- significantly decreased time to ambulation, eating solid food, and first bowel movement.
- They also were able to be discharged faster.
- They had less complaints of nausea, itching, vomiting, and abdominal pain.
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- 2020 study: Level 1 evidence supporting Exparel as a part of a multifaceted pain strategy. This was a prospective study looking at opioid pain consumption after Exparel block after elective c section. There was a 52% lower total opioid pain med consumption through 72 hours and 49% lower total through day 7.
- Gyne surgery
- Breast cancer mastectomy and reconstruction
My thoughts?
I am a surgeon, and many of these studies are based on deeper blocks, which are done by Anesthesia or done by the surgeon with ultrasound guidance. I use Exparel, and during a tummy tuck abdominoplasty I inject it into the rectus muscle sheath and incision. I have found it helps a lot. I love they find a statistically significant decrease in opioid pain medication use, better pain control, and faster return to eating, bowel habits, and walking. All of this is good for patients and lowers complications like blood clots. Avoiding opioids is just good- narcotic pain medication is addicting and constipating, and you build a tolerance with use. Having a multimodal approach to pain (ie coming at it with different types of treatments) is smart.
Again, I get this study is biased, as it was sent by the makers of Exparel. But I agree with its points, and I have seen Exparel in action, with a tangible improvement for my patient’s recovery.