Hi Bear. I have a position in Pacira PCRX. For those unaware, Exparel, their product is a local anesthetic that is encapsulated in a matrix of lipid/liposomal membranes that slowly degrade over time resulting in a more gradual release of the analgesic to the intended target area. The local anesthetic used is bupivacaine, which is the most commonly injected local anesthetic used post surgical procedures because of its longer duration of action.
Exparel was initially approved for soft tissue applications such as hemorrhoidectomy, but is now being used in many more post surgical incisions, orthopedic localized injections such as total knee arthroplasty, and more and more peripheral nerve blocks by Anesthesiologists for post pain.
A recent study of Exparel injected into the pericapsular area of the knee in TKA resulted in favorable results. 2 nerve block studies and I believe a study of localized injection for spinal surgery are forth coming.
The advantage of Exparel over regular bupivacaine is a longer duration of action. For example, after total knee arthroplasty, it is common for the surgeon to inject bupivacaine into the pericapsular area for some pain relief. Also, many surgical centers will offer peripheral nerve blocks such as an adductor canal saphenous nerve block by the anesthesiologist for post pain. Both of these procedures will have a benefit of anywhere from 4-18 hours post operatively. To increase the length of analgesia, some institutions anesthesia departments will place a catheter when doing a saphenous nerve block and run an infusion from a reservoir to enable 3-5 days worth of post pain relief. The disadvantage of this technique is it is more time intensive to place, and the catheters frequently become dis-lodged resulting in a poor result.
You have already highlighted the increased scrutiny being given to opioid/narcotic usage in patients with chronic pain issues. This is also extending into the acute care area as well. Opioids are very useful and sometimes the only medications available but they do have major side effects and limiting their use as much as is possible will increase in focus in the coming years.
Recently, I believe an important collaboration with Depuy/Synthes orthopedics will be a helpful catalyst going forward. Pacira is a small company. Getting surgeons and hospital formularies to stock Exparel in hospitals/clinics is a big job for them. Having the Depuy orthopedic sales/marketing teams collaborating with Pacira should be very helpful in this regard going forward.
I am looking at this company as a fairly long term hold for now. Limiting narcotic use as much as possible is being emphasized and I expect this to continue going forward. The collaboration with Depuy orthopedics should help bring additional sales in 2018. I’m holding a small position at present.
Scott