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New Publication Suggests Higher Opioid Use in the Postsurgical Setting May Be Linked to Extended Hospital Stay and Increased Cost of Care
“In numerous published studies, including this analysis, higher opioid
use has been associated with opioid-related adverse events, prolonged
hospitalization and increased costs of care,” said
In the study, medical records of patients undergoing TAH were reviewed to identify LOS ‘outliers,’ or patients with an LOS lasting greater than or equal to five days. Researchers matched 97 LOS outliers with an equal number of control patients who had an LOS that was less than five days, and similar baseline characteristics. Comparisons between the two groups showed that LOS outliers:
- Remained hospitalized 5.5 days longer than controls
$8,544more in total hospital charges than control patients ( $14,289vs. $5,745, respectively)
- Received more than two times the total opioid dose compared to the controls by the time of discharge
Reported a markedly higher incidence of ORAEs compared to controls
- Gastrointestinal ORAEs occurred in 44 percent of outliers compared to 19 percent of control patients; P< 0.01
- Respiratory ORAEs occurred in 12 percent of outliers compared to just one percent of control patients; P< 0.01
Although potent analgesics, opioids are associated with a wide range of
unwanted and potentially life-threatening adverse events, including
nausea, vomiting, constipation, urinary retention and respiratory
depression. A recent Sentinel
Event Alert issued by the Joint Commission details the risk for
opioid-induced oversedation and respiratory depression in certain
patient populations and recommends a multimodal approach to postsurgical
The regional health system analysis conducted by
EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia. The product combines bupivacaine with DepoFoam®, a proven product delivery technology that delivers medication over a desired time period. EXPAREL represents the first and only multivesicular liposome local anesthetic that can be utilized in the peri- or postsurgical setting in the same fashion as current local anesthetics. By utilizing the DepoFoam platform, a single dose of EXPAREL delivers bupivacaine over time, providing analgesia with reduced opioid requirements for up to 72 hours. Pivotal studies have demonstrated the safety and efficacy of EXPAREL in patients undergoing bunionectomy or hemorrhoidectomy procedures and additional studies are underway to further demonstrate the safety and efficacy in other procedures.
Important Safety Information
EXPAREL is contraindicated in obstetrical paracervical block anesthesia. EXPAREL has not been studied for use in patients younger than 18 years of age. Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Other formulations of bupivacaine should not be administered within 96 hours following administration of EXPAREL. Monitoring of cardiovascular and neurological status, as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products. Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. In clinical trials, the most common adverse reactions (incidence greater-than or equal to 10%) following EXPAREL administration were nausea, constipation, and vomiting.
Please see the full Prescribing Information for more details available at www.EXPAREL.com.
Pacira Pharmaceuticals, Inc.
James S. Scibetta, 973-254-3570
Pure Communications, Inc.
Susan Heins, 864-286-9597