Our surgeons are beginning to use Exparel (liposomal bupivacaine) injected into the surgical incision for post-op pain control. After receiving Exparel, the patient cannot receive ANY local anesthesia including lidocaine like we use for PICC insertions. Does anyone have suggestions for an alternative for these patients? I know we can use a normal saline wheal - any other ideas? Thanks!
Wendy Erickson
I hope you meant bacteriostatic saline! The preservative in this type of saline is what helps to numb the area. If the surgeons do not want you to use any of the other pharmacological local anesthetics, then your best bet is bacteriostatic saline. Infiltrate 5ml of it intradermally/subcutaneously and then massage it into the patient's arm. It does the trick but you do have to use more of it in comparison to lidocaine, especially for deeper vessels.
-David
Yep, that is what I meant - thanks.
Wendy Erickson RN
Eau Claire WI
Just got an update on this from our Pharmacy that I thought I would share. The lidocaine used for IV starts and PICC insertions IS ok to use - you just aren't supposed to use a local anesthetic into the incision again after injecting Exparel. This is per the manufacturer.
Wendy Erickson RN
Eau Claire WI
Thanks for that update. The original message had me a little confused. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
5ml of Saline? Did you mean 0.5 ml? Would be a big infiltrate....
Michael Drafz RN, CRNI, VA-BC
Clinical Lead Vascular Access Service
Sharp Metropolitan Medical Campus
San Diego, CA
I did mean the 5ml ! This amount is actually easily reabsorbed by the body. The majority of vascular access clinicians that I know are all so afraid of using generous amounts of Lidocaine and/or other anesthetics based on a number of myths that aren't true, or just because they're afraid. If you massage the amount infiltrated into the arm it will spread out into the area of the patient you're working on and more effectively numb the area. Your patients will thank you!--
-David