During the final phases of a total knee replacement surgeons will sometimes opt to inject some long acting anesthetic around the knee to decrease post-operative pain and improve mobility. Data regarding the efficacy of these injections is a little equivocal, but believers state this is because of variability in injection technique, and may also have to do with the pharmacokinetics of the anesthetic itself.
Pacira Pharmaceuticals (Parsippany, NJ) is looking to solve both of these problems by providing EXPAREL, a bupivacaine liposome injectable suspension, a long-acting local anesthetic. To address the variability in injection technique, Pacira featured a virtual reality training module at the recent American Association of Hip and Knee Surgeons (AAHKS) meeting.
The hardware set-up consists of a VR headset in addition to a haptic stylus. The stylus controls a virtual syringe that could be used to inject different areas of the intra-op knee and also different tissue types. At the end of the module feedback is provided in the form of colored heatmaps and an accuracy score.
In addition to the VR module, Pacira at the same time released a module for the surgical training phone/tablet app Touch Surgery, which is available to download for free at this time. The mobile module demonstrates the proper medications and fluids to draw up and distribute into syringes and then walks you through the recommended anatomical areas to inject.
“As a clinician who has experienced first-hand the impact of an enhanced recovery protocol in my total knee arthroplasty patients, I have found the addition of EXPAREL as part of a robust periarticular injection to be instrumental in pain relief and in patients’ postsurgical recovery. I was thrilled to be part of the working group who helped refine and perfect this comprehensive commitment to education that Pacira is making,” said Pacira’s steering committee member Stan Dysart, MD, who is a practicing orthopedic surgeon at Wellstar Kennestone and Pinnacle Orthopaedics in Marietta, GA. “In my own practice, I saw increasingly optimized and replicable outcomes with EXPAREL as I fine-tuned my infiltration technique to include an appropriate volume of solution, the proper multimodal protocol, and a precise injection technique. I am pleased to help share that insight with my colleagues and their patients alike.”