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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘exparel’

Technical Strategies in Plastic Surgery – Exparel for Rapid Recovery Breast Augmentation

Wednesday, September 17th, 2014


Breast Augmentation in Hispanic Women Dr Barry Eppley IndianapolisBreast augmentation remains one of the most popular and commonly performed elective body contouring procedures. The most frequent location for breast implants is under the pectoralis major muscle, technically a partial submuscular location known as the dual plane pocket. While this implant pocket location has numerous advantages long-term, the elevation of the muscle does not the short-term drawback immediate discomfort and some restriction of arm movement.

To counter this temporary chest muscle discomfort, rapid recovery breast augmentation protocols have been advocated for over a decade. These protocols largely rely on non-steroidal medications and immediate use of the muscle through early physical therapy. (arm range of motion) While complete muscle recovery does occur fairly quickly, there remains the immediate discomfort due to muscle injury and the pressure of the implant underneath it.

Exparel in Plastic Surgery Dr Barry Eppley IndianapolisOne tremendously effective management technique is to inject the portion of the pectoralis muscle over the implant and its sternal attachments with Exparel. This is the only local anesthetic that works for up to three days (72 hours) after tissue placement by injection. This newer local anesthetic combines bupivacaine (Marcaine) with a lipid-like delivery method known as DepoFoam. A single intraoperativhe injection at the source of the pain with either eliminate the pain completely or result in a decreased need for narcotic medications for up to 72 hours after surgery. This injection can eliminate the need for any other method of adjunctive pain relief like catheters or pumps.

Exparel has been around now for several years and has a significant history of both safety and effectiveness. It has been evaluated in over 21 clinical trials of various surgical procedures consistently demonstrating prolonged pain reduction or elimination for days after the procedure. It is thus no surprise that it works equally well in breast augmentation. It does add a few hundred dollars to the cost of the surgery but the allure of minimal pain on awakening and a return to most activities of daily life al almost immediately after raises the concept of a Rapid Recovery After Breast Augmentation protocol to a whole new level.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: Exparel Local Anesthetic

Sunday, February 10th, 2013


The use of local anesthetics is commonly done in numerous plastic surgery procedures for both immediate and prolonged pain relief. One such operation would be a tummy tuck where the rectus muscles are sutured together. This is the most common source of significant pain after the procedure. Indwelling pain pumps or the injection of long-acting Marcaine (bupivacaine which lasts up to 24 hours) into the muscle is commonly used to help control the patient’s pain after surgery. While pain pumps can work up to 48 hours after surgery they are an additional tube(s) that exits the body and adds hundreds of dollars to the cost of surgery. Injected marcaine with epinephrine will last somewhere in the range of 18 to 24 hours but no longer.

Exparel is a newer local analgesic agent that combines bupivacaine with a unique liposome delivery vehicle known as DepoFoam. This is a multivesicular liposome that entraps the local anesthetic agent and slowly releases it as it breaks down over a few days after injection. This is why the solution looks white and flows like low fat milk due to the suspended liposome particles. This allows a single dose to have a duration of effect of around 72 hours or 3 days. A large number of clinical trials (21) evaluating over 1300 patients who had various surgical procedures were tested for both safety and effectiveness.

Exparel (bupivacaine liposomal injection suspension, 1.3%) has the potential to simplify postsurgical pain management by reducing the need for oral narcotics and/or pain pumps by delivering bupivacaine with a single injection. Better postsurgical pain management may potentially result in less discomfort and earlier mobility in the first few days after a tummy tuck which is the most difficult phase of the recovery. There are other potential applications in plastic surgery where such pain control could be beneficial as well such as breast augmentation.

Dr. Barry Eppley

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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