Opioids, Postop Pain…New Results From Pacira Pharmaceuticals

What works better after total knee arthroplasty (TKA), a multi-drug analgesic cocktail for pain management or a periarticular injection of Pacira Pharmaceuticals’ EXPAREL? The results of a new, independent, physician-initiated study found that individuals treated with EXPAREL had significantly lower patient-perceived pain scores and morphine sulfate equivalence consumption, and reported higher satisfaction with pain control and overall experience, compared with those receiving the multi-drug analgesic cocktail.

“A majority of patients who undergo total knee arthroplasty report dissatisfaction with overall pain control and side effects associated with narcotic medications, so there is clearly a need for a more effective and better-tolerated pain management option, ” said Mark A. Snyder, M.D., director of the Orthopaedic Center of Excellence at Good Samaritan Hospital in Cincinnati, in the November 6, 2014 news release. “Our study found that EXPAREL not only provided effective pain control, but also reduced opioid load and improved the patient’s overall experience. In addition, we found that EXPAREL eliminated the incidence of post-operative falls, a serious patient safety risk resulting from muscle weakness associated with nerve blocks and prolonged indwelling pain catheters, and confusion or disorientation caused by opioids.”

As indicated in the news release, “The double-blind, randomized clinical study evaluated 70 TKA patients who were randomly assigned to receive either a periarticular injection with EXPAREL or a multi-drug analgesic cocktail (ketorolac, morphine, epinephrine and ropivacaine) for postsurgical analgesia.”

“The patient-perceived pain scores and high satisfaction ratings we observed suggest that EXPAREL may be a comparably effective, yet far better tolerated pain management solution than continuous femoral nerve blocks, which require catheters to deliver extended analgesia, ” added Dr. Snyder. “While larger studies are needed to drive a shift in current practice guidelines, our data and previously reported physician-led studies indicate that EXPAREL should play a vital role in the pain management paradigm for orthopedic procedures.”

Dr. Snyder told OTW, “The initially promising study outcomes associated with EXPAREL warrant a new wave of robust, double-blinded, randomized, controlled studies designed to examine characteristics such as patient tissue volume, which can impact the drug’s effect, and be used as predictive measures to optimize its efficacy, In addition, I would like to see data examining whether EXPAREL, as part of a non-narcotic multimodal pain management regimen, could reduce or eliminate the need for other analgesics such as pregabilin or COX-2 inhibitors, which are associated with side effects. Overall, we have observed that it has tremendous clinical value and versatility, and additional large-scale studies which quantify and optimize its benefits would increase its adoption and reduce the burden of opioid use after surgery.”