Dosing considerations

EXPAREL is available as a 266 mg (20 mL) single-use vial and a 133 mg (10 mL) single-use vial. The recommended dose of EXPAREL is based on:
Icon representing the scaling size of a surgical site
Size of surgical site
2 needles at different volumes to represent the varying doses based on need
Volume needed to cover the width and depth of site
Caution sign with exclamation point
Patient factors that could impact safety of an amide local anesthetic
EXPAREL is intended for single-dose administration only, and maximum dose should not exceed 266 mg (one 20 mL vial).
Choose the Appropriate Dose
Ensuring optimal analgesic coverage
Rate of absorption and onset of action of EXPAREL may vary based on vascularity of the tissue, patient factors, timing of administration, and administration technique.

Determine the right volume to cover the surgical site

Cross-section revealing example of unexpanded EXPAREL administration
Cross-section revealing example of expanded EXPAREL administration
  • Consider the size of the surgical site and the neuroanatomy
  • 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
Consider the size of the surgical site and neuroanatomy to determine expansion volume
Expanding EXPAREL
266 mg or 20 mL vial of EXPAREL
266 mg (20 mL) EXPAREL can be expanded for large surgical sites
  • Expand with normal (0.9%) saline or lactated Ringer’s solution
  • Add up to 280 mL for a total of 300 mL; a 1:14 ratio
133 mg or 10 mL vial of EXPAREL
133mg (10 mL) EXPAREL should be considered for small surgical sites
  • Sites where20 mL of EXPAREL is too much volume
  • Sites where 133 mg (~370 liposomes) sufficiently covers the area

To ensure early analgesic activity, admix with bupivacaine HCl

  • Bupivacaine HCl may be administered immediately before EXPAREL or admixed in the same syringe
  • Keep a 1:2 ratio of the milligram dose of bupivacaine HCl to EXPAREL. In determining this ratio, consider:
  • One 20 mL vial of EXPAREL contains 266 mg of free base bupivacaine, which is molar equivalent to 300 mg of bupivacaine HCl
  • One 30 mL vial of 0.5% bupivacaine contains 150 mg of bupivacaine HCI
  • Admixing may impact the pharmacokinetic/pharmacodynamic properties of EXPAREL; the effect is concentration dependent