Exciting advancements in surgery and anesthesia are being utilized at St. Anthony Regional Hospital – the use and expansion of anesthesia blocks, combined with Exparel, which is a local, long-lasting anesthetic injection. What does this mean for patients at St. Anthony? For a host of surgeries, including orthopedics, C-sections, hysterectomies, hernia repairs and more, it means quicker recovery. This also means less time in the hospital, more manageable pain and less risk of opioid dependency.
“We are always looking for ways to be more progressive with state-of-the-art anesthesia. We are doing that today by utilizing a multimodal pain management approach; that is, combining either a transverse abdominis plane [TAP] or erector spinae plane [ESP] block with a long-lasting anesthesia, Exparel,” said Ed Cutler, MSN, CRNA, St. Anthony Anesthesia Director. “Put simply, pain management is a complex process. The anesthesia team works to manage several nerve receptors to effectively control post-operative pain. This helps to minimize adverse effects, while improving patient comfort and satisfaction.”
Though Exparel has been around for many years, it was previously used only for orthopedic surgeries. However, with advancements in technology, surgeons at St. Anthony, including OB/GYN Charles Svensson, M.D. and Urogynecologist Maria Hernandez, M.D., have collaborated with the anesthesia team to utilize the cutting-edge technology for additional procedures. In fact, since his arrival at St. Anthony in February 2017, Dr. Svensson has utilized the anesthesia team’s multimodal approach on numerous hysterectomies and C-sections.
“In my many years in medicine, I have never seen patients recover from surgery so well – and it is all because of the anesthesia blocks and Exparel,” said Dr. Svensson, who explained how Exparel is formulated in a capsule of lipid, which allows a slow release of the anesthesia over a greater period of time. This equates to up to 72 hours of pain relief versus the traditional six hours.
“By the time the anesthesia wears off, patients find the pain to be much more tolerable,” Dr. Svensson said. “Even following any type of abdominal surgery or laparoscopic incision, patients are recovering much more quickly, getting up on their feet and moving around.”
One of those patients is Susan Van Erdewyk of Carroll, who underwent hysterectomy surgery this past November at the age of 52. A mother of three, Van Erdewyk experienced heavy cycles, fibroids and benign issues before seeking guidance from Dr. Svensson.
“Right away, I felt I was in good hands,” Van Erdewyk said. “Following every test along the way, Dr. Svensson and Molly Riedell [RN], would contact me. They were kind, comforting and knowledgeable. Prior to the surgery, the anesthesia team and medical staff explained the anesthesia process, told me what to expect and counseled me. I was very satisfied with my care at St. Anthony.”
Matt Earl, CRNA, St. Anthony, who introduced the ESP block to the hospital, performed Van Erdewyk’s block and anesthesia injection.
“This is still a really new procedure in our department,” Cutler said. “Matt went to a conference and brought back this technology, introducing this particular block. This type of dedication to evolving our procedures and taking a look at how we can best help our patients through the surgery process speaks volumes for our medical staff, and their commitment to the hospital and patients in west central Iowa.”
Following the hysterectomy, Van Erdewyk shares that she experienced minimal pain and only relied on over-the-counter medications for pain management. She got up during the night, and by the next morning was able to function without the catheter. A mere 24-hours after surgery, she was dressed and ready to go home.
“I expected it would take longer to heal,” Van Erdewyk said. “I thought I would feel different, but that wasn’t the case. My issues cleared up, I had more energy and overall, felt better doing what I am used to doing.”
Cutler shares the importance of reduced down time for patients following surgery, which was an important component of Van Erdewyk’s expedited recovery.
“Advancements in medicine are changing rapidly. Today, we are able to tailor anesthesia to best fit individual needs,” Cutler said. “The less pain patients experience, the more quickly they are able to get back on their feet, in turn reducing the risk for respiratory issues and blood clots; spend time at home where they can heal more quickly; and cut down on costs associated with trips to the hospital.”
Dr. Svensson removed the staples two weeks after Van Erdewyk’s surgery; and six weeks after her hysterectomy, she was cleared without restrictions.
“Most of the time, procedures like this can result in post-operative pain,” Dr. Svensson said. “Susan’s case was a significant surgery that resulted in nearly an outpatient procedure. Dr. Hernandez and I have experienced great success with these blocks and Exparel anesthesia. Patients are doing fabulous on it – and it’s not just a one-time success.”
Today, St. Anthony performs nearly 100 percent of all abdominal, hysterectomy and C-section procedures utilizing the multimodal approach.
“We have transitioned to a combination of the block and Exparel injection as a result of research and the overwhelmingly positive patient experience,” Cutler said. “The less pain patients have following surgery, the sooner they are able to regain mobility without the residual problems that result from pain.”
Van Erdewyk is thankful she moved forward with the procedure.
“The care I received at St. Anthony was as good, if not better, than anywhere you could go,” Van Erdewyk said. “I gave birth to my three children in the Twin Cities and received excellent care, and I can say that the care and compassion I received at St. Anthony is also top-notch.”
Pictured (left to right): Susan, and husband, Mike Van Erdewyk, with their three children: Martha (19), Jack (20) and Michael (22)