Issue link: https://beckershealthcare.uberflip.com/i/1499344
30 ORTHOPEDICS Why 2 orthopedic leaders prefer avoiding private equity By Carly Behm M any orthopedic and spine practices have weighed the decision of either taking private equity investment to support themselves or seeking other avenues to remain independent. Here's what two leaders have told Becker's on why they chose the second path: Frank Aluisio, MD. Physician president of EmergeOrtho (Durham, N.C.): If private equity becomes involved, then you're giving away a great deal of your independence. We feel that we're an excellent platform to help other independent groups that need help but do not want to go the private equity route. Going forward, we want PE to be synonymous with 'physician empowered' and not 'private equity.' Eric Freeman, DO. Founder and Medical Director of Redefine Healthcare (Union, N.J): What we found is that private equity doesn't know the business better than you do. I have numerous examples of colleagues of mine that went into private equity, and some of their practices don't exist today. You have to be able to assess these opportunities with private equity and look at them closely. But overall, nobody knows the practice or runs the practice better than you do. You have to have your strong team in place, and that will allow you to make the best decision for you. We have found that currently our best decision has been to stay independent. n Rothman Orthopaedics' CEO exits By Carly Behm C hristopher Olivia, MD, is leaving his post as CEO of Philadelphia- based Rothman Orthopaedic Institute, effective immediately, according to a statement shared with Becker's March 30. The orthopedic group and Dr. Olivia are "parting ways, and all at Rothman wish Dr. Olivia all the best on his future business successes," a spokesperson said in an email. Edward Tufaro, who has been Rothman's senior vice president of operations, was named interim CEO, the statement said. Dr. Olivia stepped into the CEO role in April 2021, replacing Mike West. n Dr. Brian Fiani joins Mendelson Kornblum Orthopedics and Spine Specialists By Claire Wallace B rian Fiani, DO, joined Troy, Mich.-based Mendelson Kornblum Orthopedics and Spine Specialists in his home state after spending years practicing in California and New York. Dr. Fiani is a board-certified neurosurgeon, specializing in minimally invasive spinal surgeries, including degenerative spinal surgeries and new minimally invasive techniques and robotics. n • 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