Key dosing considerations with EXPAREL

EXPAREL is available in two doses: 266 mg (20 mL) and 133 mg (10 mL). To ensure optimal analgesic coverage, the volume should be expanded for larger surgical sites. To attain early analgesic onset, bupivacaine HCl can be administered immediately before EXPAREL or admixed in the same syringe as part of the total expanded volume.

Dosing for infiltration and field blocks with EXPAREL

  • The recommended dose of EXPAREL is based on the size of the surgical site, volume required to cover the area, and individual patient factors that may impact the safety of an amide local anesthetic
  • Maximum dose should not exceed 266 mg (20 mL)
  • Dosing for EXPAREL in patients under 17 is weight based: 4 mg/kg

The 133 mg (10 mL) dose is appropriate for procedures such as*

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Facial/plastic

Foot

Hand

Oral/maxillofacial

The 266 mg (20 mL) dose is appropriate for procedures such as*

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Abdominal/colorectal/general: abdominal wall reconstruction, bariatric, colectomy, hernia, abdominal field blocks (eg, transversus abdominis plane [TAP]-block-based procedures), nephrectomy

Breast: mastectomy, breast reconstruction

Obstetric/gynecologic: myomectomy, hysterectomy, cesarean section

Orthopedic: TKA, THA, fusions/fractures

Spine: fusions, discectomy, laminectomy

*These are examples of procedures that typically require the above-referenced dose of EXPAREL. Please use your professional clinical judgment when determining the appropriate dose of EXPAREL for a given surgical procedure and refer to the full Prescribing Information before using.

Volume expansion and admixing with EXPAREL

Interscalene brachial plexus nerve block

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Use 133 mg (10 mL) of EXPAREL for interscalene brachial plexus nerve block

  • Do not exceed maximum dosage of 133 mg (10 mL) of EXPAREL

Admixing with bupivacaine HCl

  • Bupivacaine HCl can be administered immediately before EXPAREL or admixed as part of the total expanded volume§
  • Ensure ratio of milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2§
  • One 10 mL vial contains 133 mg of EXPAREL, which is a molar equivalent to 150 mg of bupivacaine HCl
    • 1:2 ratio allows 75 mg of bupivacaine HCl to 133 mg of EXPAREL
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The recommended dose is based on a study of patients undergoing either total shoulder arthroplasty or rotator cuff repair.

§Do not admix EXPAREL with any other agents prior to administration. Avoid additional use of anesthetics within 96 hours following administration of EXPAREL.

Field block

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Use 266 mg (20 mL) of EXPAREL for field blocks, such as TAP and PEC blocks

  • Do not exceed maximum dosage of 266 mg (20 mL) of EXPAREL

Volume expansion and admixing with 266 mg (20 mL) bupivacaine HCl

  • 20 mL of EXPAREL can be expanded with up to 280 mL of normal saline or lactated Ringer’s solution||
  • Ensure ratio of milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2§
  • One 20 mL vial contains 266 mg of EXPAREL, which is a molar equivalent to 300 mg of bupivacaine HCl
    • 1:2 ratio allows 150 mg of bupivacaine HCl to 266 mg of EXPAREL
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Appropriate dose and total volume to be determined based on size of surgical site, volume required to cover area, and individual patient factors that may impact safety.

||Maintain a minimum concentration of 0.89 mg/mL.

Determine the right volume to cover the surgical site

  • Consider the size, vascularity, and neuroanatomy of the surgical site
  • Expand the volume to disperse liposomes throughout the surgical site
  • Enough multivesicular liposomes must be available at the pain receptors to continuously release bupivacaine, ensuring long-lasting analgesia
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EXPAREL unexpanded

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EXPAREL expanded

The broad indication of EXPAREL affords versatility of administration

Administer as surgical site infiltration to produce local analgesia, as a field block to produce regional analgesia, or in adults, as an interscalene brachial plexus nerve block.

Administration guidance for infiltration

Infiltrate into all tissue layers to ensure complete analgesic coverage

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  • Inject EXPAREL slowly and deeply (generally 1-2 mL per injection) into soft tissues using a moving needle technique (ie, inject while withdrawing the needle)
  • Infiltrate above and below the fascia and into the subcutaneous tissue
  • Aspirate frequently to minimize the risk of intravascular injection
  • Use a 25-gauge or larger-bore needle to maintain the structural integrity of the liposomal particles
  • Inject frequently in small areas (1-1.5 cm apart) to ensure overlapping analgesic coverage

TKA, total knee arthroplasty; THA, total hip arthroplasty; PEC, pectoralis; TAP, transversus abdominis plane.