•

WelcomeCharles Kennedy

Comoderators

Girish P. Joshi, MBBS, MD, FFARCIProfessor of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical CenterDallas, Texas

David E. Beck, MD, FACSProfessor and ChairDept of Colon and Rectal SurgeryOchsner Clinic FoundationNew Orleans, Louisiana

Professor and ChairOchsner Clinical SchoolUniversity of Queensland School of MedicineAustralia

Summary of Yesterday’s DiscussionsDr Joshi

Explanation of Today’s FormatDr Beck

Review of the Pain Consortium/Congress Concept and Review of History

Dr Joshi

Review Congress Mission and GoalsDr Joshi

Brief Summaries of Research/ExperienceESC

BENEFITS OF A MULTIMODAL

REGIMEN INCLUDING LIPOSOMAL

BUPIVACAINE FOR POSTSURGICAL

PAIN IN COLORECTAL SURGERY

David E. Beck, MD

David A. Margolin, MD

Sheena Farragut Babin, PharmD Christine Theriot Russo, PharmD

Depts Colon & Rectal Surgery & Pharmacy

Ochsner Clinic Foundation

New Orleans, LA

Ochsner Medical Center

• 550 bed, tertiary-care referral center

• Five staff colon rectal surgeons

• Training institution for colon rectal

fellowships

• 800 operative colorectal cases per year

Ochsner Experience

• Retrospective Chart review :

–October 2011 – January 2013

• 179 pts : major colorectal surgery

–81pts : 266 mg liposomal bupivacaine &

multimodality pain management

–98 pts : conventional therapy (PCA)

• T-test and chi square

Ochsner Medical Center Experience

Characteristic Exparel ®

N = 66

Control

N = 167

P

value

Age (avg yrs) 59.8 54.7 ns

Gender (% Male) 39.4% 46.1% ns

Post op Pain Score

(avg)

5.5 6.6 < 0.05

Opioid Free (hrs) 5.2 2.9 < 0.05

Post Op LOS (days) 7.2 9.0 < 0.04

Cumulative Post-Operative

Narcotic Use

0

10

20

30

40

50

60

70

12-Hr 24-Hr 36-Hr 48-Hr 60-Hr 72-Hr

Exparel

Non-Exparel

mg of

morphine

P < 0.0007)

Ochsner Medical Center

Experience

Characteristic Exparel ®

N = 66

Control

N = 167

P

value

ORAE

Anti-pruritic meds

Anti-emetic

Anti-constipation

0.4

2.7

0.6

4.47

6.7

0.9

<0.03

<0.012

<0.05

• Liposomal bupivacaine : 81 pts

• Laparoscopic : 34 pts

• Open procedures : 47 pts

• No difference

– pain medication

– ORAE

Current Management• Pre-Op (Holding)

– Acetaminophen 1000 mg IV

– Ibuprofen 800 mg IV q

• Intra-OP

– Liposomal bupivacaine 266 mg (20 cc)

– Bupivacaine : 0.25% 30 cc (75 mg)

– Saline 20 cc

• Post-op

– Acetaminophen 1000 mg IV q 8 h

– Ibuprofen 800 mg IV q 6 h

– PCA

– Conversion to oral meds

• Care pathways

Conclusion

In Major CR procedures

– Liposomal bupivacaine & Multimodality pain

– Lower pain scores

– Decreased opioid use

– Less ORAE

– Decreased LOS

Clinical Case

Beck, DE18

• JB is a 75-year-old male

• 6 weeks previously had low anterior

resection and loop ileostomy for an early

rectal cancer

• Previous surgery

– Ileus, temporary mental status changes, andurinary retention with narcotics

• Normal contrast study of anastomosis

• Loop ileostomy closure

Loop Ileostomy Closure

Beck, DE19

Loop Ileostomy Closure

(continued)

• Intra-op: EXPAREL® 20 cc infiltrated into wound

20 Beck, DE

Infiltration technique

21

Radial infiltration

Two levels

− Deep

dermal

− Deep tissueBeck, DE

Clinical Case (continued)

22

• Post-op: Acetaminophen 1000 mg IV q 12 hoursIbuprofen 800 mg IV q 12 hours

• POD 2: Bowel movementStopped IV medicationOral hydrocodoneRegular diet

• POD 3: Discharged

• No IV narcotics: Avoided PCA

Beck, DE

Postoperative Pain Management

• Multi-modality

– Analgesics

• Non-opioid

• Opioid

– Exparel

• Reduced pain scores

• Decreased & Delayed OpioidRequirements

• Lowered ORAE

• Reduced Length of Stay

Brief Overview of PROSPECTDr Joshi

Break

Industry’s Role inConsortium Mission

OPEN ForumFacilitator: Dr Beck

Meeting Summary and Wrap UpDr Joshi

Lunch

This program is supported by grants from

Thank you!

Accomplishing Our Long-Term Mission

• Establish a national identity as the benchmarking organization foridentifying, developing and disseminating best practices for managingsurgical pain in the United States

• Act as a repository of surgical pain management educational materials foreducation of healthcare personnel including students and residents– Development of electronic curricula for residents which would include some

form of knowledge validation

• Development of a center of excellence certification – c.f., NAFCcertification

• Clinic safety training for use of local anesthetics – does this exist fordentistry?

• Question: suggestions for marketing/promoting the SPC and its bestpractices proceedings

• Question: at what point does the SPC consider inviting attendees to pay toattend the annual meetings or deploy satellite training courses?