Stock in Pacira Pharmaceuticals (PCRX)

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BLADEMDA said:
Here is the conclusion from the Study's Authors which is EXACTLY in agreement with me:

CONCLUSIONS: Liposome bupivacaine added to standard bupivacaine may lower pain and enhance patient's satisfaction in the first postoperative week even in the setting of multimodal analgesia for major shoulder surgery.

https://www.anesthesiologynews.com/...ds-Analgesia-for-Brachial-Plexus-Blocks/38168
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Bullsh*t.
Sorry Blade. I love ya man. But that is crap.
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Noyac said:
New Formulation of Local Anesthetic Does Not Reduce In-Hospital Opioid Use or Opioid-Related Complications After Knee Surgery
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Full disclosure. I don't use this stuff often because it's too expensive. When I do use it, it's rarely and is used off label for pain blocks

Liposomal Bupivacaine Does Not Reduce Inpatient Opioid Prescription or Related Complications after Knee Arthroplasty:A Database Analysis | Anesthesiology | ASA Publications

If you look at the paper, there is actually a 10% reduction in total OME and a small reduction 2 - 3% in days stayed, in this completely retrospective noncontrolled usage of the drug when it first rolled out. There's a signal there. Interestingly, there is no increase in cost for the hospitalization.

The next step for this company is just arguing about cost/benefit/profitability, and they just need to price it accordingly so the health system they're working with and they make money.

It isn't a magic bullet, but it's a good tool to have for sure.
 
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BLADEMDA said:
I'm glad it has FDA Approval because many more studies will be published putting an end to this notion that Exparel doesn't work.
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You keep saying that. It's hard to discuss this when you releatedly and deliberately keep misrepresenting the argument others are making.

OF COURSE EXPAREL "WORKS"

What's in question is whether it works better than plain bupivacaine or bupivacaine plus dexamethasone. And the data for its superiority just isn't there.
 
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BLADEMDA said:
Okay, so don't use it for knee surgery? That does not mean Liposomal Bupivacaine won't last 48 hours for a TAP block or ISB.
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Actually, the article I cited DOES show that Exparel for ISB does not last longer than regular bupi (not 48 hours). And there is absolutely no published data anywhere that Exparel lasts 48 hrs for either ISB or TAP (or for that matter any other block).
 
facted said:
Actually, the article I cited DOES show that Exparel for ISB does not last longer than regular bupi (not 48 hours). And there is absolutely no published data anywhere that Exparel lasts 48 hrs for either ISB or TAP (or for that matter any other block).
Click to expand...

That's not true. I've personally spoke with dozens of patients whose TAP block with Exparel lasted well beyond 36 hours. The posts on here are inaccurate and simply false made by those who don't use the local on a regular basis. I highly recommend Exparel for TAP blocks.
 
pgg said:
You keep saying that. It's hard to discuss this when you releatedly and deliberately keep misrepresenting the argument others are making.

OF COURSE EXPAREL "WORKS"

What's in question is whether it works better than plain bupivacaine or bupivacaine plus dexamethasone. And the data for its superiority just isn't there.
Click to expand...

My data and those who use it on a regular basis are convinced of its superiority. This is due to patient feedback including family members, CRNAs, Anesthesiologists and Surgeons who have received Exparel for their own blocks.

I utilize Bup with dexamethasone on a routine basis for peripheral nerve blocks. The duration of analgesia is very good. Liposomal Bupivacaine is superior to Bup with dexamethasone in terms of duration of analgesia. But, is the extra 12-24 hours of analgesia worth the additional cost of $300? I think it is.
 
BLADEMDA said:
That's not true. I've personally spoke with dozens of patients whose TAP block with Exparel lasted well beyond 36 hours. The posts on here are inaccurate and simply false made by those who don't use the local on a regular basis. I highly recommend Exparel for TAP blocks.
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BLADEMDA said:
My data and those who use it on a regular basis are convinced of its superiority. This is due to patient feedback including family members, CRNAs, Anesthesiologists and Surgeons who have received Exparel for their own blocks.
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Translation: anecdote.
 
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BLADEMDA said:
My data and those who use it on a regular basis are convinced of its superiority. This is due to patient feedback including family members, CRNAs, Anesthesiologists and Surgeons who have received Exparel for their own blocks.

I utilize Bup with dexamethasone on a routine basis for peripheral nerve blocks. The duration of analgesia is very good. Liposomal Bupivacaine is superior to Bup with dexamethasone in terms of duration of analgesia. But, is the extra 12-24 hours of analgesia worth the additional cost of $300? I think it is.
Click to expand...

Where is the publication blade?
 
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BLADEMDA said:
That's not true. I've personally spoke with dozens of patients whose TAP block with Exparel lasted well beyond 36 hours. The posts on here are inaccurate and simply false made by those who don't use the local on a regular basis. I highly recommend Exparel for TAP blocks.
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What I said is ABSOLUTELY TRUE. I said there is no PUBLISHED DATA demonstrating any of that, and that's interesting as Exparel has been approved for TAP blocks for some time now... Still no data showing superiority.
 
BLADEMDA said:
My data and those who use it on a regular basis are convinced of its superiority. This is due to patient feedback including family members, CRNAs, Anesthesiologists and Surgeons who have received Exparel for their own blocks.

I utilize Bup with dexamethasone on a routine basis for peripheral nerve blocks. The duration of analgesia is very good. Liposomal Bupivacaine is superior to Bup with dexamethasone in terms of duration of analgesia. But, is the extra 12-24 hours of analgesia worth the additional cost of $300? I think it is.
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I wish people in high volume non-academic practices like yours would publish their data. It sounds like you've kept pretty detailed records.
 
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Most anesthesiologists and surgeons (now it’s mostly surgical PAs or NPs seeing these folks at all times except in the OR) aren’t very good at followup. Exparel is taking full advantage of this. I trust the data, ever increasing, that Exparel doesn’t work for whatever reason. It’s fancy bupivacaine, but the fancy part of it isn’t doing what it’s supposed to.

Blade, I also wish you’d publish some data. You’re the rare, if not the only, anesthesiologist I know who does a very large number of blocks and follows all of those patients days out. Your anecdotal experience stands in direct contrast to all available data regarding Exparel. It’d be nice if you published.
 
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BLADEMDA said:
That's not true. I've personally spoke with dozens of patients whose TAP block with Exparel lasted well beyond 36 hours. The posts on here are inaccurate and simply false made by those who don't use the local on a regular basis. I highly recommend Exparel for TAP blocks.
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Blade, you know that this is not how science goes about approving therapeutic interventions. You also know that you can’t just subjectively ask pts how long something lasted. They are under the influence of other medications, completely uneducated in this arena and absolutely unreliable.
Look, I have nothing against you but I’m starting to doubt your claims even more than I did before. Your numbers just don’t seem real. I do my own cases so I can’t possibly achieve the block numbers of someone that supervises nurses but I’m finding your claims more difficult to believe. Especially, when not a single person here can make the same claims as you do.
I even reported our facility’s attempt at an outcomes data report that we had to stop early because Exparel was inferior to our tried and true approach.
So I appreciate your enthusiasm but your reporting is extremely biased. That’s not how science works.
 
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Resurrecting this Exparel stock thread.

My position is up over 100%, but nervous about the latest meta analysis article in this months Anesthesiology.

will probably pull some profits.
 
caligas said:
Resurrecting this Exparel stock thread.

My position is up over 100%, but nervous about the latest meta analysis article in this months Anesthesiology.

will probably pull some profits.
Click to expand...

i would dump it.
 
It probably isn’t going anywhere soon as the surgeons have already bought into it (think spine surgeons). We still use it for TSA’s... but i think the benefit is about 4 hours.
 
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caligas said:
Resurrecting this Exparel stock thread.

My position is up over 100%, but nervous about the latest meta analysis article in this months Anesthesiology.

will probably pull some profits.
Click to expand...
Kept holding on to this loser way too long but finally got about an 70% gain. I've cashed out my initial buy plus a little of the house's money and I'm letting a small portion ride.
 
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*anecdotally. Review article this month basically calls it a sham.
 
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Southpaw said:
my large health system pulled it off formulary a while back due to lack of supporting evidence. if I'd made money off pcrx I'd cash my gains and move to something else.
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What's the next made up drug that doesn't really work that we can pump up?
 
589E2AFF-1CCA-4E9C-A3E1-E297BF228E48.jpeg
 
considering this company in the healthcare sector:

Welcome to ATEC™ Spine - ATEC Spine

ATEC™ Spine is a solution-minded, problem-solving organization committed to providing outstanding patient outcomes in Carlsbad and around the world.
atecspine.com atecspine.com
 
SaltyDog said:
What makes them different than the 27 other spine hardware companies?
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Nuvasive leadership and reps bailed and joined ATEC. My buddy says they also brought 40 million worth of business.
 
Still just looking into it. Company seems to have turned a corner and on the growth part of the curve.
 
Historically , a bad chart to look at but seems to have already bottomed out.
 
Personally i am more into etf’s, but dable with some stocks.
 
Airway said:
What's the next made up drug that doesn't really work that we can pump up?
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Ketamine instead of opiates has seemed to take that role for now.. not a believer. Agree that exparel not superior.
 
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Conclusions
Perineural liposomal bupivacaine provided a statistically significant but clinically unimportant improvement in the AUC of postoperative pain scores compared with plain local anesthetic. Furthermore, this benefit was rendered nonsignificant after excluding an industry-sponsored trial, and liposomal bupivacaine was found to be not different from plain local anesthetics for postoperative pain and all other analgesic and functional outcomes. High-quality evidence does not support the use of perineural liposomal bupivacaine over nonliposomal bupivacaine for peripheral nerve blocks.

Perioperative Medicine| February 2021

Perineural Liposomal Bupivacaine Is Not Superior to Nonliposomal Bupivacaine for Peripheral Nerve Block Analgesia: A Systematic Review and Meta-analysis​

Nasir Hussain, M.D., M.Sc.;

Richard Brull, M.D.;

Brendan Sheehy, M.D.;

Michael K. Essandoh, M.D.;

David L. Stahl, M.D.;

Tristan E. Weaver, M.D.;

Faraj W. Abdallah, M.D., M.Sc.
Author and Article Information
Anesthesiology February 2021, Vol. 134, 147–164.
 
So, what is my opinion on Exparel vs Bup with dexamethasone? Well that depends on whether you use 133 mg or 266 mg dosage. IMHO, the 266 mg dosage does prolong postop analgesia vs Bup with dexamethasone but the 133 mg dosage is actually inferior to Bup with dexamethasone.

When doing field blocks like TAP, PECS, paravertebral, etc. the use of Exparel does give the patient a few extra hours of analgesia vs Bup with dexamethasone but again that is dilutional/dose dependent.

The company made a huge error by going with the 133 mg dosage for ISB because the 266 mg dosage is superior to 0.5% Bup with dexamethasone while the 133 mg dosage is not.

I can not and do not recommend the 10 ml vial (133 mg) for our typical perineural nerve blocks.
 
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I’ve said this before -

I had some in the pain clinic so used it for a trigger point to the rhomboids. I mostly inject into fascial planes (like a TAP).
The guy came back and told me his face was numb for 5 days.

Saying Exparel “doesn’t work” is like saying a BIS doesn’t work, or that Republicans are dumb, or Democrats are stupid - it’s just not true and needs a lot more qualifying.

is the company dumb? Yes. Were the inventors as dumb as nails to put the most poisonous local anesthetic with a low TI? Yes.
Does it work? Well we know if you measure serum levels of Bupi at 4 days later, plenty remains.
The truth is, it probably works in some situations, doesn't in others. This needs to be determined.
Regarding stock price, good idea to take profits.

I will always use it as long as the hospital has it around.
 
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epidural man said:
I’ve said this before -

I had some in the pain clinic so used it for a trigger point to the rhomboids. I mostly inject into facial planes (like a TAP).
The guy came back and told me his face was numb for 5 days.

Saying Exparel “doesn’t work” is like saying a BIS doesn’t work, or that Republicans are dumb, or Democrats are stupid - it’s just not true and needs a lot more qualifying.

is the company dumb? Yes. Were the inventors as dumb as nails to put the most poisonous local anesthetic with a low TI? Yes.
Does it work? Well we know if you measure serum levels of Bupi at 4 days later, plenty remains.
The truth is, it probably works in some situations, doesn't in others. This needs to be determined.
Regarding stock price, good idea to take profits.

I will always use it as long as the hospital has it around.
Click to expand...

Curious as to what cases you use it on @epidural man
 
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