Children's Hospitals Today - Summer 2022 - 8

ADVERTISEMENT
ROUNDS / FROM EXPERIENCE
* In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of
EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided
into six 5 mL aliquots, injected by visualizing the anal sphincter as a
clock face and slowly infiltrating one aliquot to each of the even numbers
to produce a field block.
Local Analgesia via Infiltration Dosing in Pediatric Patients
The recommended dose of EXPAREL for single-dose infiltration in pediatric
patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of
266 mg), and is based upon two studies of pediatric patients undergoing
either spine surgery or cardiac surgery.
Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing
in Adults
The recommended dose of EXPAREL for interscalene brachial plexus nerve
block in adults is 133 mg (10 mL), and is based upon one study of patients
undergoing either total shoulder arthroplasty or rotator cuff repair.
Compatibility Considerations
Admixing EXPAREL with drugs other than bupivacaine HCl prior to
administration is not recommended.
* Non-bupivacaine based local anesthetics, including lidocaine,
may cause an immediate release of bupivacaine from EXPAREL if
administered together locally. The administration of EXPAREL may
follow the administration of lidocaine after a delay of 20 minutes or
more.
* Bupivacaine HCl administered together with EXPAREL may impact the
pharmacokinetic and/or physicochemical properties of EXPAREL, and
this effect is concentration dependent. Therefore, bupivacaine HCl and
EXPAREL may be administered simultaneously in the same syringe,
and bupivacaine HCl may be injected immediately before EXPAREL as
long as the ratio of the milligram dose of bupivacaine HCl solution to
EXPAREL does not exceed 1:2.
The toxic effects of these drugs are additive and their administration
should be used with caution including monitoring for neurologic and
cardiovascular effects related to local anesthetic systemic toxicity.
* When a topical antiseptic such as povidone iodine (e.g., Betadine®
)
is applied, the site should be allowed to dry before EXPAREL is
administered into the surgical site. EXPAREL should not be allowed
to come into contact with antiseptics such as povidone iodine in
solution.
Studies conducted with EXPAREL demonstrated that the most common
implantable materials (polypropylene, PTFE, silicone, stainless steel, and
titanium) are not affected by the presence of EXPAREL any more than
they are by saline. None of the materials studied had an adverse effect
on EXPAREL.
Non-Interchangeability with Other Formulations of Bupivacaine
Different formulations of bupivacaine are not bioequivalent even if the
milligram dosage is the same. Therefore, it is not possible to convert
dosing from any other formulations of bupivacaine to EXPAREL and vice
versa.
Liposomal encapsulation or incorporation
in
a
lipid complex can
substantially affect a drug's functional properties relative to those of
the unencapsulated or nonlipid-associated drug. In addition, different
liposomal or lipid-complexed products with a common active ingredient
may vary from one another in the chemical composition and physical form
of the lipid component. Such differences may affect functional properties
of these drug products. Do not substitute.
CLINICAL PHARMACOLOGY
Pharmacokinetics
Administration of EXPAREL results in significant systemic plasma levels
of bupivacaine which can persist for 96 hours after local infiltration and
120 hours after interscalene brachial plexus nerve block. In general,
peripheral nerve blocks have shown systemic plasma levels of bupivacaine
for extended duration when compared to local infiltration. Systemic
plasma levels of bupivacaine following administration of EXPAREL are not
correlated with local efficacy.
PATIENT COUNSELING
Inform patients that use of local anesthetics may cause
methemoglobinemia, a serious condition that must be treated promptly.
Advise patients or caregivers to seek immediate medical attention if they or
someone in their care experience the following signs or symptoms: pale,
gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness
of breath; lightheadedness; or fatigue.
Healing hearts
A peer support group provides
stress first aid to all employees.
BY SARA JONES
T
here has been a common perception
that doctors, nurses and
others in health care never let their
jobs get to them. No matter how challenging
the day, they just put it behind
them despite how they may be feeling
on the inside. But that has never
been true, and the pandemic shone a
light on the reality. A new program at
Children's Hospital Los Angeles (CHLA)
aims to provide emotional support to
staff members suffering from jobrelated
stress.
Through the Healing Response Team
(HeaRT), peer volunteers are trained to
give in-the-moment care and support
to hospital employees who experience a
stress injury or become a second victim,
no matter their role at the hospital.
" HeaRT is rooted in the understanding
that we are all bonded to CHLA's mission
to create hope and build healthier
futures, " says Leah Rybarczyk, LCSW,
co-creator and program coordinator of
HeaRT. " We recognize that our patients
and families deserve our best, and it's
hard to be at our best when we're not
receiving care and support for the
everyday stresses of our work. "
Although CHLA isn't the only hospital
with a peer support program,
Rybarczyk points out that most other
Pacira Pharmaceuticals, Inc.
San Diego, CA 92121 USA
Patent Numbers:
6,132,766
5,891,467
5,766,627
8,182,835
Trademark of Pacira Pharmaceuticals, Inc.
For additional information call 1-855-RX-EXPAREL (1-855-793-9727)
Rx only
March 2021
8
CHILDREN'S HOSPITALS TODAY Summer 2022

Children's Hospitals Today - Summer 2022

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2022

Contents
Children's Hospitals Today - Summer 2022 - Cover1
Children's Hospitals Today - Summer 2022 - Cover2
Children's Hospitals Today - Summer 2022 - Contents
Children's Hospitals Today - Summer 2022 - 2
Children's Hospitals Today - Summer 2022 - 3
Children's Hospitals Today - Summer 2022 - 4
Children's Hospitals Today - Summer 2022 - 5
Children's Hospitals Today - Summer 2022 - 6
Children's Hospitals Today - Summer 2022 - 7
Children's Hospitals Today - Summer 2022 - 8
Children's Hospitals Today - Summer 2022 - 9
Children's Hospitals Today - Summer 2022 - 10
Children's Hospitals Today - Summer 2022 - 11
Children's Hospitals Today - Summer 2022 - 12
Children's Hospitals Today - Summer 2022 - 13
Children's Hospitals Today - Summer 2022 - 14
Children's Hospitals Today - Summer 2022 - 15
Children's Hospitals Today - Summer 2022 - 16
Children's Hospitals Today - Summer 2022 - 17
Children's Hospitals Today - Summer 2022 - 18
Children's Hospitals Today - Summer 2022 - 19
Children's Hospitals Today - Summer 2022 - 20
Children's Hospitals Today - Summer 2022 - 21
Children's Hospitals Today - Summer 2022 - 22
Children's Hospitals Today - Summer 2022 - 23
Children's Hospitals Today - Summer 2022 - 24
Children's Hospitals Today - Summer 2022 - 25
Children's Hospitals Today - Summer 2022 - 26
Children's Hospitals Today - Summer 2022 - 27
Children's Hospitals Today - Summer 2022 - 28
Children's Hospitals Today - Summer 2022 - Cover3
Children's Hospitals Today - Summer 2022 - Cover4
https://www.nxtbook.com/nxtbooks/cha/cht_summer_2022
https://www.nxtbook.com/nxtbooks/cha/cht_spring_2022
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2022
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2021
https://www.nxtbook.com/nxtbooks/cha/cht_2018spring
https://www.nxtbook.com/nxtbooks/cha/cht_2018winter
https://www.nxtbook.com/nxtbooks/cha/cht_2017fall
https://www.nxtbook.com/nxtbooks/cha/cht_2017summer
https://www.nxtbook.com/nxtbooks/cha/cht_2017spring
https://www.nxtbook.com/nxtbooks/cha/cht_2017winter
https://www.nxtbook.com/nxtbooks/cha/cht_2016fall
https://www.nxtbook.com/nxtbooks/cha/cht_2016summer
https://www.nxtbook.com/nxtbooks/cha/cht_2016spring
https://www.nxtbook.com/nxtbooks/cha/cht_2016winter
https://www.nxtbook.com/nxtbooks/cha/cht_2015fall
https://www.nxtbook.com/nxtbooks/cha/cht_2015summer
https://www.nxtbook.com/nxtbooks/cha/cht_2015spring
https://www.nxtbook.com/nxtbooks/cha/cht_2015winter
https://www.nxtbook.com/nxtbooks/cha/cht_2014fall
https://www.nxtbook.com/nxtbooks/cha/cht_2014summer
https://www.nxtbook.com/nxtbooks/cha/cht_2014spring
https://www.nxtbook.com/nxtbooks/cha/cht_2014winter
https://www.nxtbookmedia.com