Liposomal Bupivacaine, a local anesthetic, was approved in 2011 for postsurgical pain management in patients undergoing bunionectomy or hemorrhoidectomy. Its long acting, 72 hour pain relief, makes it a good alternative to opioid use. In November 2013, Exparel was added to North Fulton formulary based on clinical literature claiming long acting pain relief, reduced opioid use, eliminating the need for pain pumps and decreased length of stay. An initial evaluation in 2014 showed increased costs and no change in pump use and restrictions were implemented. The purpose of this study was to conduct a 6 month reevaluation and determine its formulary value. A retrospective chart review was conducted for patients 18 years or older who received Exparel from 4/1/14 to 9/22/14 at North Fulton Hospital and the following information was collected on these patients: concurrent Ambu pump use, concurrent IV opioid PCA use, length of stay, prescribers, indication, average pain scores on Days 1,2,3, and time o first pain med administration. 126 patients received Exparel during the study period. No patients received an Ambu Pump (ropivacaine) along with Exparel. 68 patients (54%) received a PCA in addition to Exparel. Average length of stay for all patients on Exparel was 2.9 days. Exparel was ordered by both surgeons and anesthesiologists for various procedures. The policy restriction limited use to procedures with good clinical evidence, including arthroplasties, GI procedures (colectomy), hemorrhoidectomies, and breast augmentation. Average pain scores for patients on Days 1,2 and 3 were 6.9, 6.1, and 5.6 out of 10, respectively. During the 6 month retrospective evaluation it was found that the use of Exparel did not reduce patient length of stay and simultaneously increased patient costs. Exparel was being used for indications outside the evidence based restriction policy as well as being used together with PCA pumps. It is recommended to adhere to the restriction policies previously placed, but if unable to do so a formulary review needs to be conducted.
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