How To Use EXPAREL®

  • EXPAREL is intended for single-dose administration only
  • EXPAREL should be administered with a 25-gauge or larger-bore needle
  • Vials of EXPAREL should be inverted to re-suspend the particles immediately prior to withdrawal from the vial
  • EXPAREL should be used within 4 hours of preparation in a syringe
  • The maximum dosage of EXPAREL should not exceed 266 mg (20 mL, 1.3% of undiluted drug)

Please see Dosing EXPAREL, EXPAREL Administration, and Storage and Handling sections for full information.

Administration technique: critical for success

EXPAREL should be injected slowly into soft tissues of the surgical site using a deep tissue administration technique. Aspirate frequently to check for blood and minimize the risk of intravascular injection.

  • In clinical trials, EXPAREL was infiltrated below the fascia, above the fascia, and into the subcutaneous tissue
  • When infiltrating it is important to consider the neuroanatomy of where the pain from the surgical insult originates from
  • Utilize a moving needle technique as pictured below, to cover all layers of the surgical insult and ensure delivery of EXPAREL to the areas with the greatest concentration of nerve endings
How to administer EXPAREL for postsurgical pain

Expansion

  • Volume can be expanded to accommodate larger surgical sites
    • A 20 mL vial of EXPAREL can be administered undiluted or expanded up to a total of 300 mL with normal (0.9%) saline or lactated Ringer’s solution
  • The recommended dose of EXPAREL is based on the following factors:
    • Size of the surgical site
    • Volume required to cover the area
    • Individual patient factors that may impact the safety of an amide local anesthetic
    • Maximum dose should not exceed 266 mg (one 20 mL vial)

Compatibility considerations

  • Wait 20 minutes after administration of other non-bupivacaine-based local anesthetics before administering EXPAREL into the same surgical site
  • Allow topical antiseptics to dry before administering EXPAREL into the same surgical site
  • Bupivacaine HCl may be administered immediately before EXPAREL or admixed in the same syringe, as long as the ratio of the milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2
    • Admixing may impact the pharmacokinetic and/or physiochemical properties of EXPAREL, and this effect is concentration dependent
    • The toxic effects of these drugs are additive and their administration should be used with caution, including monitoring for neurological and cardiovascular effects related to toxicity

Compatibility with medications and implantable materials commonly used during surgery1:

  • No significant interaction with the following materials:
    • Stainless steel

    • Titanium

    • Polypropylene

    • Silicone
  • In vivo compatibility studies have not been conducted, but when the following classes of compounds were tested in vitro with EXPAREL, they did not cause excessive release of bupivacaine from the liposomal formulation:
    • NSAIDs

    • Opioids

    • Epinephrine

    • Tranexamic acid

    • Corticosteroids

    • Antibiotics
  • Other than bupivacaine, EXPAREL should not be admixed with other drugs prior to administration

Video about DepoFoam®

Watch this short animation to see how DepoFoam works.

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Administering EXPAREL

View how to properly administer EXPAREL.

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EXPAREL in Oral Surgery

Find information on using EXPAREL for local infiltration in oral surgery.

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Important Notice

This site is for informational purposes only and is intended to address medical questions from healthcare professionals in the United States.

To report an adverse event, e-mail drugsafety@pacira.com or dial 1-855-RX-EXPAREL (1-855-793-9727).

For medical inquiries related to EXPAREL, submit a request to Medical Information or call 1-855-RX-EXPAREL (1-855-793-9727).

These are not all of the potential important safety considerations for EXPAREL; please see the full Prescribing Information.

Reference

  1. Kharitonov V. A review of the compatability of liposome bupivacaine with other drug products and commonly used implant materials. Postgrad Med. 2014;126(1):129-138.

Important Safety Information

EXPAREL is contraindicated in obstetrical paracervical block anesthesia.

EXPAREL has not been studied for use in patients younger than 18 years of age.

Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Formulations of bupivacaine other than EXPAREL should not be administered within 96 hours following administration of EXPAREL.

Monitoring of cardiovascular and neurological status as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products.

Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.

In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting.

Please refer to full Prescribing Information.

Important Safety Information

Medical Information

US healthcare professionals Click Here

Non-US healthcare professionals can submit a request to medinfo@pacira.com

If you are not a healthcare professional, please discuss any questions you have regarding your health or treatment with your physician, pharmacist, nurse, or other healthcare professional.

Important new information about EXPAREL®

The FDA confirms that EXPAREL has always been approved for "administration into the surgical site to produce postsurgical analgesia" for use in a variety of surgeries not limited to those studied in its pivotal trials.

"We are pleased to announce a successful collaboration with the FDA to resolve this matter in an expeditious and meaningful way that allows us to get back to the important task at hand—reducing postsurgical opioid exposure by providing a non-opioid option like EXPAREL to as many patients as appropriate."

- Dave Stack, Chief Executive Officer and Chairman of Pacira

The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.

Important Safety Information

EXPAREL is contraindicated in obstetrical paracervical block anesthesia.

EXPAREL has not been studied for use in patients younger than 18 years of age.

Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Formulations of bupivacaine other than EXPAREL should not be administered within 96 hours following administration of EXPAREL.

Monitoring of cardiovascular and neurological status as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products.

Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.

In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting.

Please refer to full Prescribing Information.

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