Lourdes surgeon performs New Jersey's first 'opioid-sparing' shoulder surgeries

• Updated on: 2018-04-21
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Lourdes surgeon performs New Jersey's first 'opioid-sparing' shoulder surgeries
Tuesday
Apr 17, 2018 at 7:17 PM
Dr. Sean McMillian, the chief of orthopedic surgery at Lourdes Medical Center of Burlington County, performed two shoulder surgeries last week with the new use of Exparel as a "nerve block."
Kelly Kultys @kellykultys
WILLINGBORO — Two of Dr. Sean McMillan’s patients from Lourdes Medical Center of Burlington County were able to undergo surgery last week and leave without needing any prescription opioids to manage their pain. They were first and second shoulder surgeries in the state, according to Lourdes Health System, to use the newly approved procedure that uses a “nerve block” designed to block the pain for shoulder-specific patients.
Both patients had shoulder arthroscopies, procedures that are used to examine and/or repair tissues both in and around the shoulder joint.
Previously, traditional nerve blocks were given to patients before the surgery for numbing and would last about 12 to 16 hours, according to McMillan, Lourdes' chief of orthopedic surgery.
“The problem is when the nerve block wears off — it's kind of like a rush,” he said. “A lot of times what the nurses will tell you and what the nurses were taught to tell you was, 'Listen, when you get home tonight even if you're in no pain start taking your pain medication because it's going to be like a rush when it wears off and you want to stay ahead of the pain.' ”
But on April 6 the U.S. Food and Drug Administration approved the use of the medication Exparel, a specific type of a numbing agent to be used as a nerve block for shoulder surgeries, McMillan said.
“Today’s action helps to fulfill a need for additional nonaddictive pain management tools by providing a new option for certain patients that can last up to 72 hours following surgery; however, its new use is limited to individuals who will undergo shoulder surgeries,” said Dr. Douglas Throckmorton, deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research, in a statement.
This approval allowed Dr. Andy Assiamah, the anesthesiologist working with McMillan, to use an ultrasound and identify nerves in the shoulder and inject Exparel around it to numb the area.
“By injecting this around the nerve what it does is, it ensures the entire extremity gets the benefit,” McMillan said. “What Experal is — it's a numbing agent. The way it's formulated is it's able to stay within the soft tissues or stay within the area of the surgery for up to 72 hours. It becomes slow release, almost like extended release.”
This is important, he said, because many patients are in the most pain for about 72 hours after surgery and that’s when they begin using narcotics to treat that post-surgery pain.
Exparel was previously used for “open surgeries,” such as hip or knee replacements, McMillan said.
“We injected this medicine, Exparel, around in the soft tissue,” he said. “That's what we call local infiltration. The benefit of that is you're getting some of that long-acting relief but because the field that it works in — it only works within a couple millimeters of the tissues around it. Patients were getting some relief but it wasn't always perfect.”
With the new allowance from the FDA, McMillan said he believes the procedure will become “mainstream” as a way to perform surgery with less risk of people using addictive opioid prescriptions. The surgeries are called "opioid-sparing" because some patients' level of pain may require the use of opioids to fully recover, but the goal is to limit it as much as possible, he said.
“We can do this procedure where we numb the shoulder with this long-acting medicine and then we augment that with Tylenol or Motrin post surgery when you're kind of sore,” he said. “And that should be all you need or at least save the narcotics for if you really, really need it.”
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