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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘local anesthetics’

The Use of Microcannulas for Injecting Local Anesthetics in Plastic Surgery

Friday, April 5th, 2013


The use microcannulas has been a major advance in the delivery of injectable fillers. Besides a dramatic decrease in discomfort they result in no risk of bruising…two major improvements over that of traditional needlle delivery approaches. Despite these very obvious benefits, which are apparent in one’s very first use of them, I observe very little awareness amongst physician’s and patient alike. Talking about it with my colleagues or patients makes it seem like it is a completely foreign concept even though microcannulas have been around now for a few years.

One area that microcannulas really excel is in the treatment of facial areas which are most concerning for pain and bruising. Injecting fillers into the tear troughs, lower eyelids and the lips with the use of microcannulas has become much more comfortable knowing the wide safety margin with a blunt-tipped device. While there is a very minor learning curve to their use, blunt tips allow one to ‘learn’ as much as needed in a patient without inflicting pain on them. While the skin still has to be penetrated by a needle to make an entry site through the skinĀ  for the microcannula to pass through, this is a very small scarifice to gain their benefits.

But microcannulas can be used for more than just injecting synthetic fillers. They can be equally useful for injecting local anesthestics in the office or for fully awake procedures, either in broad areas like for facial laser resurfacing or for lip or eyelid surgery. This makes the most difficult part of the procedure for the patient infinitely easier as well as virtually bruise-free. I just did a patient today who came in from out of town for a lip reduction and wanted to have it done under a local anesthestic. Injecting his upper and lower lips with a microcannula took away the most challenging part of the procedure both for him and for me!

The most interesting part of microcannulas to me is what took so long for the concept to be come clinically available. Fat has been extracted for decades by the use of large cannulas and the numbing and hemostatic solution to make it possible is infused with a much smaller cannula. I suspect this was an issue of the technology and machinery to do it. It is incredible that even done at the very small 30 gauge level a microcannula is available for use.

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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