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How To Use EXPAREL®

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 syringe1

Non-Opioid Postsurgical Pain Control, You Control

Diagram illustrating how to administer EXPAREL

You Control the Administration

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.1

  • Consider infiltrating above and below the fascia to treat pain that originates from cutting through the musculature and fascia
  • Consider infiltrating into the subcutaneous tissue along the length of the surgical site to treat pain originating from the initial surgical incision

You Control the Volume

The volume of EXPAREL may be expanded with up to 280 mL of normal sterile saline to ensure sufficient coverage of larger surgical sites.

  • The recommended dose of EXPAREL is based on the surgical site and the volume required to cover the area
    • The maximum dosage should not exceed 266 mg (one 20 mL vial)

EXPAREL Administration Precautions

  • Do not admix EXPAREL with other drugs prior to administration1
  • When administering lidocaine or other non-bupivacaine based local anesthetics into the surgical site, wait at least 20 minutes before administering EXPAREL1
  • Allow topical antiseptics (e.g., Betadine®) to dry before administering EXPAREL into the same surgical site
  • When using bupivacaine HCl before EXPAREL, use no more than 50% of the total EXPAREL dose (as reference, 50 mL of 0.25% and 25 mL of 0.5% bupivacaine HCl both equate to a total dose of 125 mg)
  • When using bupivacaine HCl before EXPAREL, the mg dose of bupivacaine HCl should be ≤50% of the mg dose of EXPAREL
    • 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
    • As reference, 50 mL 0.25% or 25 mL 0.5% bupivacaine HCl each equate to 125 mg

Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL.1

Do Not Interchange with Other Formulations of Bupivacaine

Different formulations of bupivacaine are not bioequivalent, even if the milligram strength is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL.1

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EXPAREL Patient Website

If You Are a Patient

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

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View the reimbursement guide for EXPAREL

Reimbursement Guide

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How to use EXPAREL

How to Use EXPAREL

Learn about the technique clinicians are using to administer EXPAREL. > More


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

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How to use EXPAREL

How to Use EXPAREL

Learn about the technique clinicians are using to administer EXPAREL.. > More


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

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

Learn About EXPAREL

Watch this short animation to see how EXPAREL works. > More


How to Use EXPAREL

Learn about the technique clinicians are using to administer EXPAREL. > More


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

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Sign up to receive updates on EXPAREL

Sign Up

Sign up to receive updates on EXPAREL. > Sign Up


How to use EXPAREL

How to Use EXPAREL

Learn about the technique clinicians are using to administer EXPAREL. > More


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

[an error occurred while processing this directive]

Learn About EXPAREL

Video animation illustrating how EXPAREL works

Watch this short animation to see how EXPAREL works. > More


Sign up to receive updates on EXPAREL

Sign Up

Sign up to receive updates on EXPAREL. > Sign Up


How to use EXPAREL

How to Use EXPAREL

Learn about the technique clinicians are using to administer EXPAREL. > More


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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]
Sign Up

Sign Up

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Clinical Studies

Clinical Studies

See the clinical data from the pivotal soft tissue trial for EXPAREL. > More


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

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Sign Up

Sign Up

Sign up to receive updates on EXPAREL. > Sign Up


Clinical Studies

Clinical Studies

See the clinical data from the pivotal soft tissue trial for EXPAREL. > More


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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]
Is EXPAREL Right for My Patients

Is EXPAREL Right for My Patients?

Find out if EXPAREL could meet a need in your practice. > More


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

[an error occurred while processing this directive]

Is EXPAREL Right for My Patients?

Find out if EXPAREL could meet a need in your practice. > More


Clinical Studies

See the clinical data from the pivotal soft tissue trial for EXPAREL. > More


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

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EXPAREL Efficacy

EXPAREL Efficacy

Find out more about the efficacy of EXPAREL. > More


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

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

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Benefits of EXPAREL

The EXPAREL Difference

Learn about the benefits of this innovative, non-opioid analgesic. > More


Is EXPAREL Right for My Patients

Is EXPAREL Right for My Patients?

Find out if EXPAREL could meet a need in your practice. > More


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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]

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

[an error occurred while processing this directive]
Benefits of EXPAREL

The EXPAREL Difference

Learn about the benefits of this innovative, non-opioid analgesic. > More


Is EXPAREL Right for My Patients

Is EXPAREL Right for My Patients?

Find out if EXPAREL could meet a need in your practice. > More


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

[an error occurred while processing this directive]
Benefits of EXPAREL

The EXPAREL Difference

Learn about the benefits of this innovative, non-opioid analgesic. > More


Is EXPAREL Right for My Patients

Is EXPAREL Right for My Patients?

Find out if EXPAREL could meet a need in your practice. > More


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

[an error occurred while processing this directive]

The EXPAREL Difference

Learn about the benefits of this innovative, non-opioid analgesic. > More


Patient Benefits

Learn how EXPAREL may result in patient satisfaction for your practice. > More


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

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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, contact Medical Information at medinfo@pacira.com or 1-855-RX-EXPAREL (1-855-793-9727).

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To report Suspected Adverse Reactions, contact Pacira Pharmaceuticals, Inc. at 1-855-RX-EXPAREL (1-855-793-9727) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

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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, contact Medical Information at medinfo@pacira.com or 1-855-RX-EXPAREL (1-855-793-9727).

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*Pivotal studies have demonstrated the safety and efficacy of EXPAREL in patients undergoing bunionectomy or hemorrhoidectomy procedures; additional studies are underway to further demonstrate the safety and efficacy in other procedures.

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

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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, contact Medical Information at medinfo@pacira.com or 1-855-RX-EXPAREL (1-855-793-9727).

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References:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
  2. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
  3. Safe Use of Opioids. The Joint Commission Sentinel Event Alert. Issue 49; August 8, 2013.
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References:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
  2. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
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References:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
  2. Beauregard L, Pomp A, et al. Severity and impact of pain after day-surgery. Can J Anaesth.1998;45(4):304-311.
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Reference:

  1. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
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References:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
  2. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
  3. Golf M, Daniels SE, et al. A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. 2011; 28(9):776-788.
  4. Bergese SD, Onel E, Portillo J. Evaluation of DepoFoam bupivacaine for the treatment of postsurgical pain. Pain Management. November 2011; 1(6):539-547.
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References:

  1. Naseem A, Harada T,Wang D, et al. Bupivacaine extended release liposome injection does not prolong QTc interval in a thorough QT/QTc study in healthy volunteers. J Clin Pharmacol. November 4, 2011.
  2. Bergese SD, Onel E, Portillo J. Evaluation of DepoFoam bupivacaine for the treatment of postsurgical pain. Pain Management. November 2011; 1(6):539-547.
  3. American Society of Regional Anesthesia. Checklist for Treatment of Local Anesthetic Systemic Toxicity. Available at: http://www.asra.com/checklist-for-local-anesthetic-toxicity-treatment-1-18-12.pdf. Accessed June 15, 2012.
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Reference:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
[an error occurred while processing this directive]

References:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
  2. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
[an error occurred while processing this directive]

Reference:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
[an error occurred while processing this directive]

Reference:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
[an error occurred while processing this directive]

Reference:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
[an error occurred while processing this directive]

Reference:

  1. EXPAREL [prescribing information]. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; 2011.
[an error occurred while processing this directive]

Reference:

  1. Pacira Pharmaceuticals, Inc. www.pacira.com. Accessed November 4, 2011.
[an error occurred while processing this directive]

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, contact Medical Information at medinfo@pacira.com or 1-855-RX-EXPAREL (1-855-793-9727).

Reference:

  1. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
[an error occurred while processing this directive]

Reference:

  1. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
[an error occurred while processing this directive]

References:

  1. Gorfine SR, Onel E, et al. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Diseases of the Colon & Rectum. 2011;54(12):1552-1559.
  2. Beauregard L, Pomp A, et al. Severity and impact of pain after day-surgery. Can J Anaesth.1998;45(4):304-311.
  3. Safe Use of Opioids. The Joint Commission Sentinel Event Alert. Issue 49, August 8, 2012.
  4. Schug SA, et al. Best Pract Res Clin Anaesthesiol. 2011;25(1):73-81.
  5. Passannante AN, et al. Anesthesiol Clin North America. 2005;23(3):479-491.
  6. Ingrande J, et al. Br J Anaesth. 2010;105 Suppl 1:i16-i23.
  7. Lee M, et al. Pain Physician. 2011;14(2):145-161.
  8. Rozen D, et al. J Opioid Manag. 2006;2(6):353-363.
  9. Fong HK, et al. Anesth Analg. 2006;102(4):1255-1266.
  10. National Opioid Use Guideline Group (NOUGG). Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. 2010.
  11. Wilder-Smith OH. Eur J Pain. 2005;9(2):137-140.
  12. Chou R, et al. J Pain. 2009;10(2):113-130.
  13. Verhamme KM, et al. Drug Saf. 2008;31(5):373-388.
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Important Safety Information

EXPAREL is indicated for single-dose administration into the surgical site to produce postsurgical analgesia.


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. Other formulations of bupivacaine 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.


Studies demonstrating the safety and efficacy of EXPAREL were conducted in hemorrhoidectomy and bunionectomy; EXPAREL has not been demonstrated to be safe and effective in other procedures.


Please see the full Prescribing Information for EXPAREL.

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