Robert Whitfield MD explains that a solo explant surgery takes about 2.5 hours under general anesthesia. He uses multi-site nerve blockade with liposomal bupivacaine injected along intercostal borders and muscle surfaces to minimize postoperative pain and reduce narcotic needs.
Approximately two and a half hours.
General anesthesia using a laryngeal mask airway.
Exparel (liposomal bupivacaine).
If I'm doing an explant alone, no other procedures, I will book the case for approximately two and a half hours. This is done under general anesthesia using what's called a laryngeal mask airway. That's an area that sits not down past the vocal cords, but in the back of the throat. There's less of an instance of sore throat, but you still can have some. One of the big things I try to do is that the completion of that explant and the completion of cleansing the pocket is performed and an intercostal nerve block. So I am looking at every rib cartilage, every rib itself. I see all the intercostal muscles, which are the muscles that connect the ribs together. So I take exparel, which is a liposomal bupivacaine, and I inject it into the areas where I operated. The point being is to block the nerves that run along the border, inferior or lower border of the rib, as well as the muscular surfaces of the pectoralis major minor, their nerves, and the serratus anterior, and sometimes the top of the rectus abdominis. If you do that consistently, side to side, case after case, you will diminish your patient's need for both narcotic, which is great narcotically, all sorts of complications that we don't want. But you'll be up doing more, you'll feel better sooner, you won't wake up in pain. My patients don't wake up having significant discomfort because I've done all these steps already in an explant to block what will be interpreted by the patient's brain as pain.
