To help you through your patient journey, we spoke with Dr. Lucian Panait, a general surgery specialist and bariatric weight loss surgeon at the North Memorial Health Hospital and Minnesota Hernia Center in Minneapolis, MN. Dr. Panait is also the president of the Minnesota Bariatric Center and has 24 years of experience specializing in general surgery, bariatric surgery, and laparoscopic surgery. Over the last five years, Dr. Panait has worked to enhance the recovery experience for his bariatric patients, including the use of non-opioid pain management options before, during, and after surgery. He tells us more about his approach below and in a recent podcast- click HERE to listen and HERE to watch.
Pre-Surgery Prep
Dr. Panait shared that it’s important for patients to be comfortable in their environment prior to surgery. There’s an emotional, mental, and physical aspect to bariatric surgery. Therefore, it’s important to have trust and a constructive relationship before, during, and after surgery with your surgeon and surgical team. Patients should also focus on their diet and fitness plan before surgery since some may need to lose weight and change their eating habits to qualify for certain bariatric surgeries. This helps prepare the body for surgery and start a healthy routine and diet.
Like any other surgery, Dr. Panait shared that bariatric patients are concerned not only with the actual procedure – what it entails and how long it will take them to recover – but also with how much pain they will experience and what their recovery will look like once they return home. During this pre-surgery stage, he recommends that patients discuss pain management plans and non-opioid options with their healthcare provider. Narcotics or opioids can be detrimental to a patient’s recovery process and are also associated with a long list of side effects – including confusion, nausea, dizziness, dependence or addiction, and more – which can hinder the recovery process.
Pain Management Options
A significant part of Dr. Panait's approach to bariatric surgery involves pain management. He emphasizes the importance of minimizing trauma from surgery and expediting recovery. Notably, his strategy includes having patients start to walk a few hours post-surgery to prevent complications like deep vein thrombosis, which can lead to potentially life-threatening conditions.
We discussed many pain management options with Dr. Panait but found that his use of EXPAREL® (bupivacaine liposome injectable suspension), a long-acting numbing medication that is injected directly into the abdominal wall to block the nerves in the area, has been able to provide his patients with an enhanced recovery process after surgery. EXPAREL slowly delivers medication for the first few days after surgery, when patients need pain relief the most. This non-opioid option essentially keeps the local anesthetic in the body for a few days rather than a few hours after surgery, thus allowing patients to decrease the need for or avoid the use of narcotics in the recovery phase.
Postsurgical Experience and EXPAREL
Dr. Panait says that introducing EXPAREL has been “life-changing” for his patients and “practice-changing” for him due to his ability to reduce narcotic prescriptions and get patients home to recover sooner. He shared that patients typically spend 2-4 hours in the recovery room after their surgery, but then can go home and recover. This allows patients to get up and walk and get a good night’s rest in their own beds. When they return the next day for a post-op check-up, he says patients report minimal to no pain. Many of these patients are able to manage their pain with just acetaminophen or other non-narcotic medications. This is a significant shift in postoperative care.
EXPAREL has also helped his patients avoid transfer addictions. Dr. Panait explained that while patients often don’t realize it, recovery from weight loss surgery is just as much a mental and emotional battle as it is a physical one. Many bariatric patients getting weight loss surgery have a tough relationship with food and diet habits which, if not treated, can turn into an addiction. After surgery, this addiction can transfer to the narcotics that were prescribed to help with pain management. This is one big aspect Dr. Panait wants to avoid.
Recovery Beyond Surgery
Dr. Panait emphasizes that bariatric surgery is only a tool and that patients must know how to use the tool afterward to be successful. Surgery is just the beginning of a lifelong commitment to health, including a balanced diet, regular exercise, and vitamin supplementation. He emphasizes that a strong support system – such as family, friends, and groups like BariNation – is critical for a successful recovery journey.
Enhancing this journey also starts with patients advocating for themselves. If you don’t feel like you are getting the information, attention, or treatment you need, Dr. Panait stresses the importance of seeking out another healthcare provider. If there is something that concerns you about your body, and a provider dismisses it, get a second opinion.
It’s also important to ask your doctor whether they use non-opioids to manage pain during initial discussions prior to surgery. Dr. Panait advises all patients to inquire about non-opioid options and seek alternative healthcare providers if necessary. You should feel empowered to consult with different providers who may have a treatment plan that fits better with your recovery goals.
For more information, visit www.YourXFactor.com to learn about non-opioid options or listen to the full podcast discussion with Dr. Panait.
This blog post is sponsored by Pacira BioSciences, Inc., the manufacturer of EXPAREL. Dr. Panait is a paid consultant of Pacira BioSciences, Inc.
*This is based on Dr. Panait’s own experience using EXPAREL. Results may vary.
Indication
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.
Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, headache, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
Full Prescribing Information is available at www.EXPAREL.com/patient.
For more information, please visit www.EXPAREL.com/patient or call 1-855-793-9727.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.