Welcome Charles Kennedy

Welcome Charles Kennedy

Comoderators Girish P. Joshi, MBBS, MD, FFARCI Professor of Anesthesiology and Pain Management University of Texas Southwestern Medical Center Dallas, Texas David E. Beck, MD, FACS Professor and Chair Dept of Colon and Rectal Surgery Ochsner Clinic Foundation New Orleans, Louisiana Professor and Chair Ochsner Clinical School University of Queensland School of Medicine Australia

Summary of Yesterday s Discussions Dr Joshi

Explanation of Today s Format Dr Beck

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

Review Congress Mission and Goals Dr Joshi

Brief Summaries of Research/Experience ESC

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 70 60 mg of morphine 50 40 30 20 10 Exparel Non-Exparel 0 12-Hr 24-Hr 36-Hr 48-Hr 60-Hr 72-Hr P < 0.0007)

Ochsner Medical Center Experience Characteristic Exparel N = 66 ORAE Anti-pruritic meds 0.4 Anti-emetic 2.7 Anti-constipation 0.6 Control N = 167 4.47 6.7 0.9 P value <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 18 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, and urinary retention with narcotics Normal contrast study of anastomosis Loop ileostomy closure Beck, DE

Loop Ileostomy Closure 19 Beck, DE

Loop Ileostomy Closure (continued) Intra-op: EXPAREL 20 cc infiltrated into wound 20 Beck, DE

Infiltration technique Radial infiltration 21 Beck, DE Two levels Deep dermal Deep tissue

Clinical Case (continued) Post-op: Acetaminophen 1000 mg IV q 12 hours Ibuprofen 800 mg IV q 12 hours POD 2: Bowel movement Stopped IV medication Oral hydrocodone Regular diet POD 3: Discharged No IV narcotics: Avoided PCA 22 Beck, DE

Postoperative Pain Management Multi-modality Analgesics Non-opioid Opioid Exparel Reduced pain scores Decreased & Delayed Opioid Requirements Lowered ORAE Reduced Length of Stay

Brief Overview of PROSPECT Dr Joshi

Break

Industry s Role in Consortium Mission

OPEN Forum Facilitator: Dr Beck

Meeting Summary and Wrap Up Dr Joshi

Lunch

This program is supported by grants from

Thank you!

Accomplishing Our Long-Term Mission Establish a national identity as the benchmarking organization for identifying, developing and disseminating best practices for managing surgical pain in the United States Act as a repository of surgical pain management educational materials for education 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., NAFC certification Clinic safety training for use of local anesthetics does this exist for dentistry? Question: suggestions for marketing/promoting the SPC and its best practices proceedings Question: at what point does the SPC consider inviting attendees to pay to attend the annual meetings or deploy satellite training courses?