Zynrelef > LIA Cocktail > Bupivacaine = Exparel

[anonymous]

Literature Review:
Which method of local infiltration analgesia provides the best patient outcomes for length of stay, pain scores, and opioid consumption?

Exparel (Liposomal Bupivacaine) = Generic Bupivacaine (High Quality Meta-Analysis/Prospective Studies)

LIA Cocktail (Ropivacaine, Toradol, Epi, Morphine) > Bupivacaine (High Quality Meta-Analysis)
LIA Cocktail > Exparel (High Quality Meta-Analysis)

Zynrelef > Bupivacaine (Well controlled FDA approved Clinical trials) (Mfg.)
Zynrelef > Exparel (Single Center Retrospective) (X 2 studies)
Zynrelef > LIA Cocktail (Large N, multiple providers, MMA, Restrospective) (X2 studies)

More data needed but things are stacking up in favor of Zynrelef. Well controlled head to head prospective studies Zynrelef vs. LIA vs. Bupivacaine vs. Exparel for various indications is necessary.

Efficacy: Zynrelef (Bupivacaine Meloxicam) > LIA Cocktail > Bupivacaine = Exparel (Liposomal Bupivacaine)
Cost: Exparel ($360) > Zynrelef ($200-$260) > LIA Cocktail ($50-$150) > Bupivacaine (<$5)
Reimbursement: Zynrelef only product reimbursed outside DRG at HOPD/ASC, (Exparel in ASC), Cocktails/Generic Bupivacaine not reimbursed.
Administration:
Instillation (Zynrelef) = No Ultrasound Guidance or Specialized Training; Admin Time <2min, better coverage of local pain producing tissues.
Infiltration/Injection (LIA Cocktail, Bupivacaine, Exparel) = Specialized Training, Admin Time 5-15 min, risk of intravascular administration (cardiac arrhythmias), increased trauma/pain, increased bruising and hematoma risk.

 

[anonymous]

Black Box = Zenrelef

 

[anonymous]

We just adopted zynrelef at our institution. We reviewed the literature thoroughly and the black box warning was not of any real concern in our teams opinion. Zynrelef was not associated with any of the outcomes in the warning in clinical trials. It only received the black box warning because it contains meloxicam which has the identical black box warning. The risks associated with meloxicam identified in the warning are associated with long term use. The low dose of meloxicam contained in zynrelef has not shown this effect nor do any clinicians expect it to be significant from a single low dose. Bottom line Benefits significantly outweigh risks.

 

[anonymous]

We just adopted zynrelef at our institution. We reviewed the literature thoroughly and the black box warning was not of any real concern in our teams opinion. Zynrelef was not associated with any of the outcomes in the warning in clinical trials. It only received the black box warning because it contains meloxicam which has the identical black box warning. The risks associated with meloxicam identified in the warning are associated with long term use. The low dose of meloxicam contained in zynrelef has not shown this effect nor do any clinicians expect it to be significant from a single low dose. Bottom line Benefits significantly outweigh risks.

First, you don’t work at a hospital. You’re a liar.

Second, thank you for sharing your entire BS sales pitch. You’re a dumb ass.

 

[anonymous]

First, you don’t work at a hospital. You’re a liar.

Second, thank you for sharing your entire BS sales pitch. You’re a dumb ass.

First, no reason to lie. Second I am a Dr. And have no affiliation or reason to sell you anything. I am here to report the literature and report best practices in pain management trying to lessen the impact of the opioid epidemic.

 

[anonymous]

First, no reason to lie. Second I am a Dr. And have no affiliation or reason to sell you anything. I am here to report the literature and report best practices in pain management trying to lessen the impact of the opioid epidemic.

You’re obviously not a doctor. Because doctors don’t care about lessening the impact of the opioid epidemic. They couldn’t care less. I talk to doctors every day. Turning their noses up at proven, data substantiated non-opioid modalities because they don’t make enough money using them. Not willing to lift a finger to fight for something that has the potential to “lessen the impact of the opioid epidemic”. Doctors who tell me their patients take little to no narcotics because their just so amazing, only to have their PA’s confiding in me that they just want all the calls from patients for Med refills to stop once the doc leaves the room. Happens everyday. An absolute disconnect from reality.

Doctors only care about one thing: making money. So let’s not insult everybody with the time and basic linguistic skills necessary to read with your BS.

 

[anonymous]

Thanks for the sales pitch doc.

 

[anonymous]

You’re obviously not a doctor. Because doctors don’t care about lessening the impact of the opioid epidemic. They couldn’t care less. I talk to doctors every day. Turning their noses up at proven, data substantiated non-opioid modalities because they don’t make enough money using them. Not willing to lift a finger to fight for something that has the potential to “lessen the impact of the opioid epidemic”. Doctors who tell me their patients take little to no narcotics because their just so amazing, only to have their PA’s confiding in me that they just want all the calls from patients for Med refills to stop once the doc leaves the room. Happens everyday. An absolute disconnect from reality.

Doctors only care about one thing: making money. So let’s not insult everybody with the time and basic linguistic skills necessary to read with your BS.

Your comments are very disrespectful and false. One day you will be happy to experience the "care" of a Dr. Maybe the reason for the reactions you observed are related to the fact that the product you represent exparel does not add benefit to patient care. Exparel has been around for over a decade and proven many times over to be no benefit but the company continues to push it.

Sorry if the truth is alarming to you but zynrelef and LIA cocktails are both superior products and provide our patients the best possible outcomes. Go read it for yourself all the literature is public.

 

[anonymous]

You’re obviously not a doctor. Because doctors don’t care about lessening the impact of the opioid epidemic. They couldn’t care less. I talk to doctors every day. Turning their noses up at proven, data substantiated non-opioid modalities because they don’t make enough money using them. Not willing to lift a finger to fight for something that has the potential to “lessen the impact of the opioid epidemic”. Doctors who tell me their patients take little to no narcotics because their just so amazing, only to have their PA’s confiding in me that they just want all the calls from patients for Med refills to stop once the doc leaves the room. Happens everyday. An absolute disconnect from reality.

Doctors only care about one thing: making money. So let’s not insult everybody with the time and basic linguistic skills necessary to read with your BS.

Your comments are very disrespectful to the entire medical community. I dont believe for one second it is because all Dr.'s do not care. One day you will need a Dr. to "care" for you and maybe you will show a little appreciation then. It sounds to me that you are a Pacira rep selling Exparel which the literature has shown over and over again for a decade does not improve upon standards of care. Maybe that is why you feel we do not listen or care about your product but the fact of the matter is Exparel provides no additional benefit to our patients. Our institution rejected Exparel from formulary on multiple occasions as reps continually convinced medical and non-medical executives to have us evaluate. We are a data driven institution and always came to the same conclusion on Exparel and rejected it and the false claims the reps or Pacira was claiming. On the other hand Zynrelef had strong data supporting it over standard of care and has already shown to have a significant impact in our provider group with decrease in LOS, Pain Scores, and Opioid Use for patients undergoing total knee arthroplasty. We implemented zynrelef to minimize opioid use and improve patient outcomes...because we care.

 

[anonymous]

This is ridiculous, you are an insult to anyone with an MD after their name. Stop the BS and prepare for Heron to fail as a company or get bought out.

 

[anonymous]

This is ridiculous, you are an insult to anyone with an MD after their name. Stop the BS and prepare for Heron to fail as a company or get bought out.

Someone sounds a little salty. Dr. is hear posting legitimate scientific rational and you only have insults. How about you add some constructive information for your side. Dr. did not insult you only discussed lack of efficacy from Exparel. You must be a pacira employee since you took offense. Dr. gotcha for sure. I am with Dr. on the efficacy of Zynrelef and need for opioid alternatives. We also recently added to formulary and are launching in May. (stumbled on the blog from data above.) Thanks Dr.

 

[anonymous]

If a surgeon is taking his time to post on cafe Pharma or even knew that it existed I would question if it’s a real post. If it’s a real surgeon reading this next time ask the rep how much they make. Because after finding out he will not be using exparel or zynrelef.

 

[anonymous]

Your comments are very disrespectful to the entire medical community. I dont believe for one second it is because all Dr.'s do not care. One day you will need a Dr. to "care" for you and maybe you will show a little appreciation then. It sounds to me that you are a Pacira rep selling Exparel which the literature has shown over and over again for a decade does not improve upon standards of care. Maybe that is why you feel we do not listen or care about your product but the fact of the matter is Exparel provides no additional benefit to our patients. Our institution rejected Exparel from formulary on multiple occasions as reps continually convinced medical and non-medical executives to have us evaluate. We are a data driven institution and always came to the same conclusion on Exparel and rejected it and the false claims the reps or Pacira was claiming. On the other hand Zynrelef had strong data supporting it over standard of care and has already shown to have a significant impact in our provider group with decrease in LOS, Pain Scores, and Opioid Use for patients undergoing total knee arthroplasty. We implemented zynrelef to minimize opioid use and improve patient outcomes...because we care.

This is the stupidest $hit that has ever been said. If you’re a doctor, which you most definitely are not, but if you are, I pray for you’re victims…I mean patients.