EXPAREL...Is it the end of Post Operative Pain?

The US Food and Drug Administration today approved a novel long-acting nonopioid anesthetic/analgesic for postsurgical pain: bupivacaine extended-release liposome injection (Exparel, Pacira Pharmaceuticals).
Exparel consists of bupivacaine encapsulated in the multivesicular liposome DepoFoam, Pacira Pharmaceutical's extended drug-delivery technology that is the basis for 2 products already on the market: DepoCyte (cytarabine liposome injection) and DepoDur (morphine sulfate extended-release liposome injection).

The new product is designed to extend the duration of analgesia provided by bupivacaine. Based on clinical trial data, Exparel provides continuous and extended postsurgical analgesia for up to 72 hours compared with bupivacaine's analgesic time of 7 hours or less, the company notes.

Exparel has been shown safe in more than 1300 patients across 21 studies, the company says. Most recently, the product was shown to be safe and effective in 2 multicenter, randomized, double-blinded, placebo-controlled, pivotal phase 3 clinical trials in patients undergoing hemorrhoidectomy and bunionectomy.

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power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is caffeine prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...

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