Long-lasting EXPAREL significantly improved BOTH clinical and economic outcomes1,2
In a prospective, 13-site, multicenter, randomized clinical trial, EXPAREL significantly improved postsurgical recovery when used in a transversus abdominis plane (TAP) block after C-section1
- Primary end point: EXPAREL reduced opioid consumption by 52%, compared with standard bupivacaine, over 72 hours and maintained an opioid-minimizing effect over 2 weeks1*

LSM, least squares mean; MED, morphine equivalent dosing.
- 2.2 times more patients were opioid-spared† (54% vs 25%, respectively; P=0.0012)1
- Safety profiles were similar in both groups1
- The evaluated safety population included women who breastfed1
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.
†Defined as patients who took no more than 1 oxycodone 10-mg tablet (or equivalent) with no reported opioid-related adverse events (ORAEs) through 72 hours.
In a retrospective study of women undergoing C-section, EXPAREL significantly reduced opioid consumption and provided significantly better pain control vs the existing standard multimodal protocol (P<0.001)2

0.7 DAYS SOONER
2.9 days (n=97) vs 3.6 days (n=89; P=0.006)
20% improvement

1 DAY SOONER
2.9 days (n=97) vs 3.9 days (n=89; P<0.001)
26% reduction

12 HOURS FASTER
18.7 hours (n=67) vs 30.7 hours (n=60; P<0.001)
39% reduction

9.8 HOURS FASTER
22.3 hours (n=67) vs 32.1 hours (n=60; P<0.008)
31% reduction

7.5 HOURS FASTER
21.6 hours (n=67) vs 29.1 hours (n=60; P<0.05)
26% reduction
LOS, length of stay.
The most commonly reported ORAEs with EXPAREL were pruritus (44%), nausea (37%), and vomiting (16%).

†The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.
Click here to see how EXPAREL is administered in C-Section (Infiltration)
Click here to read the C-Section (TAP) study
Just published - Randomized Controlled Trial Studying EXPAREL in C-Section
American College of Obstetricians and Gynecologists (ACOG) recommends a multimodal pain management approach as key to reducing pain after childbirth3
Effective pain management is critical to optimize outcomes following childbirth2
Inadequate management of postsurgical pain can interfere with maternal-infant bonding and is associated with2
- Delayed recovery
- Postpartum depression
- Persistent pain
- Reduced success with breastfeeding
- ACOG suggests women undergoing C-section may benefit from local anesthetics delivered by wound infiltration or TAP block3
Click here to read the ACOG Committee opinion on postpartum pain management
The retrospective study was designed to evaluate safety and efficacy of a multimodal pain management protocol with EXPAREL in a TAP block vs the existing standard multimodal protocol2
- A single-center, retrospective review of charts from 201 consecutive women aged 18 to 65 years at Texas Children’s Hospital Pavilion for Women between 2012 and 2015
- Patients underwent elective, unscheduled, or emergency C-section
- Procedures followed a multimodal pain management protocol with EXPAREL TAP block vs existing multimodal protocol alone with a multimodal pain management protocol or the same protocol with the addition of ultrasound-guided TAP block with EXPAREL
- Spinal-epidural anesthesia with intrathecal morphine (100 μg), plus supplemental IV analgesics:
- Dosing of IV analgesics was based on patient-reported pain intensity assessed using a numeric rating scale (NRS) (range, 0 [no pain] to 10 [worst possible pain])
- NRS scores of 1-5: patients received 3 doses of IV acetaminophen 10 mg/mL (15 mg/kg if body weight <50 kg; 1000 mg if body weight ≥50 kg) q6h, alternated with 3 doses of IV ketorolac 30 mg q6h for 24 hours
- NRS scores of 6-10: patients received IV nalbuphine 2 mg, a mixed opioid agonist–antagonist combination, every 2 hours as needed for breakthrough pain for 24 hours
- Dosing of IV analgesics was based on patient-reported pain intensity assessed using a numeric rating scale (NRS) (range, 0 [no pain] to 10 [worst possible pain])
Multimodal pain management protocol, plus:
- Addition of ultrasound-guided EXPAREL TAP block
- 266 mg (20 mL) EXPAREL admixed with 30 mL 0.25% bupivacaine HCl expanded with 30 mL normal saline (80 mL total admixture; 40 mL of EXPAREL admixture per side)
The prospective C-section study was a randomized, controlled, double-blind investigation using a multimodal protocol with EXPAREL in a TAP block vs standard bupivacaine in patients undergoing elective C-section and given spinal anesthesia1‡
- Multicenter study including 13 sites and 186 patients1
- Patients were randomized to receive 20 mL EXPAREL 266 mg, 20 mL 0.25% bupivacaine HCl, and 20 mL normal saline (30 mL volume on each side) for a total volume of 60 mL OR 20 mL 0.25% bupivacaine HCl and 40 mL normal saline (30 mL volume on each side; total volume of 60 mL) alone administered via TAP block after surgery1
- Efficacy was evaluated in a prespecified modified intent-to-treat (mITT) population who met study protocol criteria regarding proper administration of TAP and multimodal regimen1
Primary End Point
- Total postsurgical opioid consumption (mg) in oral MED through 72 hours
- Multicenter, randomized, double-blind, active-controlled phase 4 study
- Adults with term pregnancies of 37-42 weeks were randomized 1:1 to receive
- 20 mL EXPAREL 266 mg, 20 mL 0.25% bupivacaine HCl, and 20 mL normal saline (30 mL volume on each side) for a total volume of 60 mL
or
- 20 mL 0.25% bupivacaine HCl and 40 mL normal saline (30 mL volume on each side) for a total volume of 60 mL
- 20 mL EXPAREL 266 mg, 20 mL 0.25% bupivacaine HCl, and 20 mL normal saline (30 mL volume on each side) for a total volume of 60 mL
- Prior to C-section, all patients received
- An intrathecal injection of morphine (or hydromorphone) along with a single shot of bupivacaine HCl and fentanyl
- At the end of surgery all patients received
- Intravenous (IV) ketorolac 15 mg and IV acetaminophen 1000 mg followed by oral acetaminophen 650 mg and ibuprofen 600 mg every 6 hours (q6h) for ≤72 hours or until discharge
- Efficacy was evaluated in an mITT analysis set, which included all randomized patients who underwent C-section and met the study criteria for correct TAP placement, local anesthetic dosing, and a multimodal postsurgical analgesic regimen
- The ultrasound images for TAP placement for each patient were adjudicated blindly by an independent review committee to assess whether the TAP block was performed correctly
- Two independent reviewers were assigned for each patient
- If needed, a third reviewer was assigned to make a final determination
‡Measured using the area under the curve of imputed pain intensity scores collected from 6 to 72 hours (LSM [SE], 147.9 [21.13] vs 178.5 [19.78]), respectively.