Becker's ASC Review

11 ASC MANAGEMENT • 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. 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 Cardiology group sues SSM Health for $50M over lost hospital privileges By Laura Dyrda S t. Louis Heart and Vascular sued SSM Health March 31 to prevent it from entering into an exclusive contract with another cardiology provider for adult services, according to a report in the St. Louis Post-Dispatch. Five details: 1. St. Louis Heart and Vascular argues in the lawsuit that the exclusive contract would limit its ability "to compete for and treat adult cardiac patients" because it would no longer have privileges at SSM hospitals. 2. SSM told the Post-Dispatch its exclusive contract would improve care and business practices. The St. Louis-based system also said that St. Louis Heart and Vascular physicians can still see patients at other area hospitals and at the group's surgery center. 3. St. Louis Heart and Vascular's lawsuit is seeking $50 million in dam- ages from SSM. 4. SSM hospitals granted St. Louis Heart and Vascular physicians privileges for almost 30 years, and in 2016 the group spent more than $15 million to open a practice across the street from the system's DePaul Hospital. 5. St. Louis Heart and Vascular physicians performed 770 procedures on patients at SSM facilities last year. n OptumCare is changing physician pay to drive revenue growth By Laura Dyrda O ptumCare, part of OptumHealth, is transitioning physicians to value-based payment models in an effort to reach its goal of be- coming a $100 billion business, according to an Insider report. The contracts pay a flat fee to physician practices for managing patient care. The practices receive payment upfront instead of billing at the time of care. Two million of the 20 million patients in OptumCare's net- work are currently included in the fixed payment plans, and the com- pany aims to add 250,000 more by the end of the year. "We're paid to keep people healthy and well, which is what most peo- ple want," OptumHealth CEO Wyatt Decker, MD, told Insider. "When you begin to pencil out the math, as we move people into value-based arrangements, that will be a major driver of how we'll move to a $100 billion book of business." OptumCare has 56,000 physicians in its network and aims to add at least 4,000 more this year. The flat-fee payments aim to support physi- cians who keep patients out of expensive sites of care, such as hospitals and emergency rooms. Dr. Decker said OptumCare physicians referring patients to network ASCs cuts costs in half as compared to referring patients for surgery at the hospital. n

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