WEBVTT - Dr Hutchins_Open Hysterectomy TAP_PP-EX-US-7272 CC Transcript_09FEB22 1 00:07.500 --> 00:09.000 Hi. I’m Dr. Jake Hutchins from the University of Minnesota Medical 2 00:09.001 --> 00:13.000 Center. I’m the Director of our regional acute pain program, which is a 3 00:13.001 --> 00:18.000 perioperative and interventional pain service. And today I'll be doing an 4 00:18.001 --> 00:25.000 iTAP procedure for a patient undergoing a open hysterectomy and 5 00:25.001 --> 00:28.000 pelvic mass removal. 53 year old female patient. 6 00:28.001 --> 00:32.000 So for the actual procedure, I will with 0.2 to 5% bupivacaine with 7 00:32.001 --> 00:38.000 epinephrine 1 to 200,000. I’ll use that to help find the space and find the correct 8 00:38.001 --> 00:43.000 plane in the transversus abdominus underneath the facial plane. Once I am 9 00:43.001 --> 00:48.499 sure I’m in the correct plane and not intravascular, then I will use 30 mLs 10 00:48.500 --> 00:54.000 of a solution from the 20 mLs of the EXPAREL, which I’ve expanded to 11 00:54.001 --> 01:00.000 60 mLs with 2.9% normal saline. I'll take 30 mLs of that solution and inject 12 01:00.001 --> 01:02.000 it on either side for the TAP.   13 01:02.001 --> 01:05.499 So now will come in with our bupivacaine quarter percent to 14 01:05.500 --> 01:07.000 find the actual spot   15 01:09.000 --> 01:11.000 and test wrench a vascular injection.   16 01:20.500 --> 01:22.000 Ok, get a cc there.   17 01:23.500 --> 01:27.000 Beautiful. Stop. Now, switch to the EXPAREL.   18 01:28.000 --> 01:30.499 And we’ll do 3 syringes or 30 mLs of that.   19 01:38.500 --> 01:40.499 Ok. Keep it in hip.   20 01:42.000 --> 01:47.000 A little bit of more pressure. Just giving the last 10 mLs of this medication. 21 01:55.500 --> 02:02.000 We started using EXPAREL in October of 2012 and since then we've had very 22 02:02.001 --> 02:08.000 good results in over 350 iTAP procedures. We’ve used this in a 23 02:08.001 --> 02:12.499 wide variety of surgical procedures in the abdomen and have had very good 24 02:12.500 --> 02:18.499 results in terms of very good pain control in the recovery room as well as 25 02:18.500 --> 02:24.000 pain control postoperatively for the up to 72 hours after surgery. In conjunction 26 02:24.001 --> 02:29.499 with EXPAREL, we try to avoid opioids in the majority of our patients if able, 27 02:29.500 --> 02:34.000 and so will use other non-opioid therapies that help treat our patients 28 02:34.001 --> 02:38.000 pain in order to minimize opioids as much as we can and we've been very 29 02:38.001 --> 02:40.499 successful at that in our patient population.