I'm looking to see if anyone has had errors in which Exparel is being given pre-op and then receiving a subsequent dose during the procedure or at closure. Specifically targeting patients who may have received the max 20mL (266mg) already, and then received a duplicate 20 mL plus standard bupivacaine.

If you have, what have you done to prevent subsequent errors? Do you have CDS alerts, etc in place or physical barriers? We are utilizing Epic and looking for input on better optimization. Thanks!

We have recently had a few of our orthopedists and anesthesiologists inquire about using low dose methadone peri-operatively at doses of 0.1-0.3mg/kg and was curious if any of your facilities had any related experiences you'd care to share. Obviously, with methadone's t1/2 of 12-60 hours, even considering using long-acting opioids for acute pain management gives me significant pause,b ut would also be concerned about QTc effects with increased methadone use. Thoughts?

We have recently had a few of our orthopedists and anesthesiologists inquire about using low dose methadone peri-operatively at doses of 0.1-0.3mg/kg and was curious if any of your facilities had any related experiences you'd care to share. Obviously, with methadone's t1/2 of 12-60 hours, even considering using long-acting opioids for acute pain management gives me significant pause,b ut would also be concerned about QTc effects with increased methadone use. Thoughts?