Popliteal block: Exparel®'s Game-Changing FDA Approval

[@ZzzzZz-pk2yq]

I have incredible respect for both you and Dr. Gadsden. However, any time Pacira is involved, I’m skeptical.

[@nysoravideo]

Thank you, for your comment Zzzzz! It takes courage and wisdom to step out like this! Could you provide more details about Pacira? I believe the community would appreciate understanding the general sentiment towards it. Additionally, there's a distinction between pharmaceutical products and the management/marketing aspects of the pharmaceutical business. Which of these two areas poses a challenge? Best regards.

[@nicolascrescimone]

I had a patient with 4 days of complete motor block and over a weeks of no pain with 10mls of exparel and 10mls of .5% Bupi

[@DontEatCream]

Oh good, they approved something I've been doing for the past 2 years.

[@DRBLUESNYC]

Awesome comment! What are you clinical experiences with Exparel in poplital block? Greetings

[@plamiification]

Has it been tested with ankle block ? Because i imagine that patient can walk with a prolonged motor block ?

[@Corona-abc]

Can be diluted to analgesic dose ?

[@akshayuttarwar3240]

Nice to know more indication for exparel, unfortunately in india it's still not there, plus cost constraints will definitely affect its use here. But I'm glad and open to new things, our experience and continuous betterment in use of such drug will guide us to know if its good or not, everything new if it's good, will survive the test of time if we're open to explore and experiment.

[@loganclemons4961]

Dr. Hadzic would you please link Dr. Gadsen's paper in the description?

[@DRBLUESNYC]

Greetings. The paper is cited in the video. Here it is: below. Greetings! J Clin Anesth . 2024 Jun:94:111402. doi: 10.1016/j.jclinane.2024.111402. Epub 2024 Feb 9. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy Gary Schwartz 1, Jeffrey C Gadsden 2, Jeffrey Gonzales 3, Jacob Hutchins 4, Jia Song 5, O'Dane Brady 6, Mary DiGiorgi 7, Roy Winston 8

[@nysoravideo]

Here's the link to the publication: pubmed.ncbi.nlm.nih.gov/38340677/

[@TheTigers00001]

There is a new long acting LA in the pipeline. Chinese scientists are working with a compound called LALA 50 (long acting local anaestheitic 50 hours). Interesting times.

[@valeriovalente5104]

Do you have some papers about this?

[@badassnewbie]

This all sounds great, but it's hard to trust a pharm company who tried to sue a peer-reviewed publication (and the largest one in the country at that) over results they didn't like.

[@nysoravideo]

There's a distinction among pharmaceutical products, the management and marketing facets of the pharmaceutical industry, and scientific research - each represented by different groups of professionals with their own objectives and perspectives. If you have reservations about the COMPANY producing Product "A", yet the product is effective, successfully used and reported effective for a specific indication, it would be logical to separate your assessment of the product's value from your feelings about the company that manufactures it. Regardless, we hear your sentiment abut the lawsuit, though - reading the details - it appears that the issues at hand were way beyond the dislike for the results in the publication. Greetings!

[@chandras4563]

Incidence of dvt?

[@ДенисФедосеев-й4ь]

По практическое руководству Майкла Малроя, подколенная блокада Ропивакаином 0,5-40,0. Обезболивание обычно на 1 сутки, одной пациентки с повреждение ахиллова сухожилия обезболивание длилось 2 суток

[@alexbondarev8986]

Ропивакаином не пользуюсь вообще во первых нет, во вторых - а какой смысл?. Обычно на операции на голени (как правило разнообразные переломы) ввожу 0.5% маркаин -10 мл и 1% лидокаин 10 мл для именно поплитеал блока +- феморал. Под ультрасауном. Работает как минимум 24 часа. А то и больше. Для операций из за hallus Valgus использую ankle block без ультрасауна, причем как правило достаточно только медиальной стороны. То же работает более суток, общий объем около 20 мл, редко 25. Под седацией без опиатов. Люди довольны. Не помню, чтобы не работал.

[@ДенисФедосеев-й4ь]

У меня получалось обезболить максимум на 2 суток Ропивакаином

[@alexbondarev8986]

какой блок применяли, коллега? Какой объем?

[@ИринаСавинская-л4р]

Как именно?

[@valeriovalente5104]

Why would we use such an expensive drug when we can use much cheaper adjuvants?

[@nysoravideo]

The FDA unnaproved adjuvants prolong the block +/- 3-4 hours. Adjuvants do not have a site of action. Liposome-released local anesthetics do. Sodium channels. Greetings

[@nicolascrescimone]

It's not that expensive for the duration of action. Much cheaper than a catheter

[@TheHalothane]

Dr. Gadsden (and myself) have noticed a duration of action that exceeds by 3-4 fold that achieved with LA + adjuvant. This is a game changing use of liposomal bupivacaine.