WEBVTT

00:01:03.730 --> 00:01:04.064
Hi, I'm

00:01:04.064 --> 00:01:07.534
Doctor Jake Hutchins from the University
of Minnesota Medical Center.

00:01:08.001 --> 00:01:10.603
I’m the director of our regional acute
pain program,

00:01:10.603 --> 00:01:13.606
which is the Perioperative
and Interventional pain service.

00:01:13.940 --> 00:01:16.943
And today, I was doing an ITAP procedure

00:01:17.977 --> 00:01:20.080
for a patient undergoing

00:01:20.080 --> 00:01:23.850
a open hysterectomy
and pelvic mass removal.

00:01:23.983 --> 00:01:25.852
53 year old female patient.

00:01:25.852 --> 00:01:29.222
So for the actual procedure,
I will start with 0.25%

00:01:29.222 --> 00:01:32.225
bupivacaine with epinephrine 1 to 200,000.

00:01:32.425 --> 00:01:36.029
I'll use that to help find the space
and find the correct

00:01:36.096 --> 00:01:39.099
plane in the transversus abdominis
underneath the fascial plane.

00:01:39.833 --> 00:01:42.102
Once I'm ensured
that I'm in the correct plane

00:01:42.102 --> 00:01:45.105
and not intravascular, then I will use

00:01:45.472 --> 00:01:50.143
30mL of a solution
from the 20mL of the EXPAREL,

00:01:50.376 --> 00:01:54.481
which I've expanded to 60mL with 0.9%
normal saline.

00:01:54.914 --> 00:01:59.586
I'll take 30mL of that solution
and inject it on either side for the TAP.

00:01:59.853 --> 00:02:04.791
So now we'll come in with our bupivacaine
quarter percent to find the actual spot.

00:02:06.893 --> 00:02:09.863
And test for intravascular injection.

00:02:18.471 --> 00:02:18.771
Okay.

00:02:18.771 --> 00:02:20.707
Give a cc there.

00:02:20.707 --> 00:02:22.609
Beautiful, stop.

00:02:22.609 --> 00:02:25.578
Now switch to the EXPAREL

00:02:25.578 --> 00:02:28.581
and we'll do three syringes
or 30mL of that.

00:02:36.623 --> 00:02:36.990
Okay.

00:02:36.990 --> 00:02:39.826
Keep it in.

00:02:39.826 --> 00:02:42.228
A little bit of more pressure.

00:02:42.228 --> 00:02:42.562
Let's go.

00:02:42.562 --> 00:02:45.565
The last 10 mL of this medication.

00:02:53.273 --> 00:02:57.577
We started using EXPAREL
in October of 2012.

00:02:58.044 --> 00:03:00.713
And since then we've had very good results

00:03:00.713 --> 00:03:03.750
in over 350 ITAP procedures.

00:03:04.350 --> 00:03:08.755
We've used this in a wide variety
of surgical procedures in the abdomen,

00:03:09.322 --> 00:03:12.292
and have had very good results in terms of

00:03:12.525 --> 00:03:16.462
very good pain control
in the recovery room, as well as pain

00:03:16.462 --> 00:03:20.633
control postoperatively
for the up to 72 hours after surgery.

00:03:20.867 --> 00:03:24.037
In conjunction with EXPAREL,
we tried to avoid

00:03:24.470 --> 00:03:27.273
opioids in the majority of our patients,
if able.

00:03:27.273 --> 00:03:30.710
And so we'll use other
non-opioid therapies to help treat

00:03:31.177 --> 00:03:34.681
our patients pain in order to minimize
opioids as much as we can.

00:03:34.681 --> 00:03:38.284
And we've been very successful
at that in our patient population