Why non-opioid pain management options are a crucial part of the patient experience

Dr. Thomas King
Orthopedic Surgeon and Director, The Knee, Hip and Shoulder Center in Portsmouth, NH; Consultant for Pacira BioSciences, Inc.

As an orthopedic surgeon for over 20 years, it has been important for me to seek out the latest innovations in care that will allow me to provide my patients with the best overall experience. I founded the Knee, Hip and Shoulder Center in Portsmouth in 2003 and have been pioneering efforts to enhance recovery after joint replacement procedures ever since.

Over the years, our team has become aware and sensitive to the devastating opioid epidemic occurring across the nation – including here in New Hampshire. According to the Centers for Disease Control and Prevention (CDC), New Hampshire providers wrote 46.1 opioid prescriptions for every 100 persons in 2018. Knowing the impact that opioid overprescribing after surgery can have on this crisis, I made it my mission to transition to a multimodal pain management protocol for my joint replacement patients utilizing non-opioid options. In my practice, this approach has led to a nearly 90% reduction in opioid prescriptions, with many patients noting they never used any opioids prescribed after surgery.

A major contributing factor to what we call our AVATAR process (Alignment of Vital Assets To Accelerate Recovery), a program designed to improve patient outcomes through education and multimodal pain management, is a non-opioid option called EXPAREL® (bupivacaine liposome injectable suspension). EXPAREL is a long-acting local anesthetic injected during surgery to help control pain by slowly releasing a numbing medication into the body for the first few (and often most painful) days after surgery.

Since implementing this protocol with EXPAREL, many of my patients are home within 24 hours of surgery and report a better recovery experience. For example, many physical therapists who work with our patients following surgery note they are having less pain and more motion at the onset of their recovery. This is important for long-term healing because pain can limit patients’ rehabilitation. Further, a handful of patients have undergone a joint replacement with both our old and new pain management protocol and report an entirely different, enhanced recovery experience after receiving non-opioid options to manage their pain.

As surgeons, our responsibility to care for patients shouldn’t end when they leave the operating room. A swift and successful recovery can be just as important as the procedure itself, and EXPAREL has aided tremendously in providing my patients with an improved recovery experience while also minimizing their exposure to opioids.

For more information, please visit http://www.EXPAREL.com/safety.

This piece is sponsored by Pacira BioSciences, Inc.

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

EXPAREL should not be used in obstetrical paracervical block anesthesia.

In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.

In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.

In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.

EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.

EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.

Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.

EXPAREL should not be injected into the spine, joints, or veins.

The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.