Comparison of cost and outcomes in patients receiving thoracic epidural versus liposomal Bupivacaine for video-assisted thoracoscopic pulmonary resection

DR. CHARLES E. LUCAS (Detroit, Michigan): The authors have presented a video assisted thorascopic pulmonary resection that they're utilizing for pain control a thoracic epidural versus an intraoperative intercostal block. In terms of the learning experience and learning curve that the administrating surgeons would have to overcome, when we inject the EXPAREL intrathoracically between the intercostal nerve spaces, we obviously have to be careful not to hit any of the vascular bundles around the ribs, but we have to administer it in a location where it does hit the nerves. Prior to our introduction of EXPAREL into the VATS procedure, that pain pump, if you will, was tried in the past and some of the limitations that are associated with the external catheter, of course, a foreign body that's within the patient that requires removal after surgery, as well, the inherent risks of wound infection and surgical site infections as well.