Children's Hospitals Today - Fall 2022 - 8

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ROUNDS / FIRST PERSON
* 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.
A day in the life
Here's why I swap places with
a teammate every month.
BY GIL PERI
S
erving as a leader is a privilege and
a humbling responsibility-especially
in health care, where the stakes
and pressure to perform are so high
and the consequences of mistakes can
be so devastating.
That's why throughout my career I
have always looked for creative ways to
connect with and get to know my teams
better. Doing so helps me better understand
where they find their passion and
joy at work. I use that knowledge to find
ways to help them perform at their best,
which is a critical role of a leader.
One of the best ways I've discovered
to do this is by swapping jobs with team
members. That gives me a chance to walk
in their shoes and to see the real-life
context of their work that performance
reports can't convey.
I traditionally swap with other leaders,
but I have also swapped with frontline
team members, like a cafeteria
cashier. If you want
an interesting perspective
on the organization, work
a shift behind the register
during the busy lunch rush!
In the 13 months I've
view with a more qualitative and nuanced
picture of how they work together and
the issues they face as they do their jobs.
One of my recent swaps was with our
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
been at Riley Children's
Health in Indianapolis, I've
swapped jobs eight times.
The process for deciding who I'll swap jobs
with is simple. At the end of our extended
leadership meetings, I'll ask for a show of
hands of directors or managers who would
like to swap jobs with me, and my assistant
closes her eyes and randomly selects one.
Before I start a new job swap, I spend
some time becoming familiar with the
unit's key performance indicators to get
a quantitative picture of the team and its
work. Of course, the reason to spend time
with them is to balance that data-based
8
LEADERS CAN ONLY BE
EFFECTIVE IF THEY ARE
IN TOUCH WITH THE
TEAMS THEY LEAD.
PICU co-manager, Jessalynn Parsley.
The unit was very busy, with 26 highacuity
patients, including a child being
treated following a serious car accident.
I also had time to talk
to team members about
patient volumes, staffing
and hiring concerns, and
other top-of-mind issues.
I observed and listened
carefully to a quality and
safety huddle where the
team reviewed the unit's
harm events and identified
root causes. And at the end of their
shift, I watched the co-manager conduct
what we call " team member stay interviews, "
asking each of them what the
organization could do to support them
as they continue to make an impact at
Riley Children's. This has become essential
as staffing challenges intensify. The
team seems to appreciate my interest in
understanding what matters to them, and
I am a better leader after hearing directly
from our team members.
CHILDREN'S HOSPITALS TODAY Fall 2022
Children's Hospitals Today - Fall 2022

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