EXPAREL can help reduce or eliminate the use of opioids for acute postsurgical pain

EXPAREL has multiple indications for the treatment of your patients

  • Efficacy
  • Safety
  • Dosing
  • Administration
See the EXPAREL technique in practice
Watch videos and review case studies of specific procedures.

Do you use EXPAREL?

Sign up for the Surgeon Selector so patients searching for an opioid-reducing approach can find you.

Sign up

The unique drug delivery system of EXPAREL contributes to its proven safety and tolerability

Learn more about DepoFoam®

Now available in 2 doses to better meet your patients' needs

Download the dosing brochure

Efficacy

Non-opioid EXPAREL provides significant long-lasting pain control while reducing opioid use1-3

EXPAREL vs bupivacaine HCI in total knee arthroplasty (TKA)1 study
EXPAREL vs bupivacaine HCI in total knee arthroplasty (TKA)

Results from an EXPAREL phase 4, double-blind, randomized, controlled trial that compared the efficacy and safety of EXPAREL 266 mg (20 mL) (n=70) and bupivacaine HCl (n=69) in a TKA study. Primary end points: area under the curve (AUC) of visual analog scale pain intensity scores 12 to 48 hours postsurgery; total opioid consumption 0 to 48 hours postsurgery. Rescue opioids for pain were available upon patient request. Rates and types of adverse events were similar between treatment groups. The most common adverse events were nausea, dizziness, and muscle spasms.

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

Data from patients undergoing a hemorrhoidectomy2,3
Data from patients undergoing a soft-tissue surgery

Results from a phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial that evaluated the safety and efficacy of 266 mg (20 mL) EXPAREL in 186 patients undergoing 2- or 3-column excisional hemorrhoidectomy. Primary end point: cumulative pain score reflected in AUC of numeric rating scale through 72 hours. Placebo was preservative-free saline for injection. Opioid rescue medication (up to 10 mg morphine administered intramuscularly) was available to all patients.

Results vs placebo through 72 hours. Opioid reduction calculated based on geometric mean ratio.

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

EXPAREL prolonged the time to first opioid use by 14 hours2

Median time to first opioid use
Median time to first opioid use

EXPAREL can reduce or eliminate the need for opioids 2 *

In a hemorrhoidectomy study of EXPAREL vs placebo2
3 out of 10 PATIENTS WHO RECEIVED EXPAREL were opioid free

Through day 3 postsurgery

28% with exparel

(n=95)

vs

P<0.0008

10% with placebo

(n=94)
In a TKA study of EXPAREL vs bupivacaine HCI1
1 out of 10 PATIENTS WHO RECEIVED EXPAREL were opioid free

Through days 2 & 3 postsurgery

10% with exparel

(n=70)

vs

P=0.01

0% with bupivacaine HCI

(n=69)

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

Rates and types of adverse events were similar between treatment groups. The most common adverse events were nausea, dizziness, and muscle spasms.

Safety

EXPAREL has a proven safety and tolerability profile

  • Safety was evaluated in 10 wound infiltration trials
    • 823 patients underwent a variety of surgical procedures
    • EXPAREL doses ranged from 66 to 532 mg
  • Most common adverse events (AEs; incidence ≥10%) were nausea, constipation, and vomiting
  • EXPAREL demonstrated a favorable cardiac safety profile1,2
    • No detectable cardiac toxicity signal
    • No QTc prolongation, even at supratherapeutic doses
Treatment-emergent AEs (TEAEs) with an incidence ≥2%: Local infiltration placebo-controlled studies
BunionectomyHemorrhoidectomy
EXPARELPlaceboEXPARELPlacebo
System Organ Class preferred term
8 mL/1.3%
(106 mg)
(N=97)
n (%)
(N=96)
n (%)
10 mL/1.3%
(266 mg)
(N=95)
n (%)
(N=94)
n (%)
Any TEAE53 (54.6)59 (61.5)10 (10.5)17 (18.1)
Gastrointestinal disorders41 (42.3)38 (39.6)7 (7.4)13 (13.8)
Nausea39 (40.2)36 (37.5)2 (2.1)1 (1.1)
Vomiting27 (27.8)17 (17.7)2 (2.1)4 (4.3)
Nervous system disorders20 (20.6)30 (31.3)0 (0.0)0 (0.0)
Somnolence5 (5.2)1 (1.0)0 (0.0)0 (0.0)
For a complete list of TEAEs, please refer to Table 1 in the full Prescribing Information.
Bunionectomy
EXPARELPlacebo
System Organ Class preferred term
8 mL/1.3%
(106 mg)
(N=97)
n (%)
(N=96)
n (%)
Any TEAE53 (54.6)59 (61.5)
Gastrointestinal disorders41 (42.3)38 (39.6)
Nausea39 (40.2)36 (37.5)
Vomiting27 (27.8)17 (17.7)
Nervous system disorders20 (20.6)30 (31.3)
Somnolence5 (5.2)1 (1.0)
Hemorrhoidectomy
EXPARELPlacebo
System Organ Class preferred term
10 mL/1.3%
(266 mg)
(N=95)
n (%)
(N=94)
n (%)
Any TEAE10 (10.5)17 (18.1)
Gastrointestinal disorders7 (7.4)13 (13.8)
Nausea2 (2.1)1 (1.1)
Vomiting2 (2.1)4 (4.3)
Nervous system disorders0 (0.0)0 (0.0)
Somnolence0 (0.0)0 (0.0)
For a complete list of TEAEs, please refer to Table 1 in the full Prescribing Information.

EXPAREL is designed to reliably release low-dose bupivacaine over time

At the maximum recommended dose of EXPAREL, 266 mg, plasma levels of bupivacaine remain below toxicity thresholds3-5

  • Central nervous system symptoms occurred at a plasma concentration of ≈2000 ng/mL with bupivacaine HCl4
  • Cardiac toxicity is associated with blood levels of ≥4000 ng/mL5
Review detailed pharmacokinetic data

Dosing

Choose the appropriate dose

EXPAREL is available as 266 mg (20 mL) and 133 mg (10 mL) single-dose use vials. The recommended dose of EXPAREL is based on

Size of surgical site

Volume needed to cover the width and depth of site

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 (20 mL).

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

  • 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
  • Transversus abdominis plane (TAP) blocks require large volumes of local anesthetic to obtain reliable blockade

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 (10 mL) EXPAREL should be considered for small surgical sites

  • Sites where 20 mL of EXPAREL is too much volume
  • Sites where 133 mg (≈370 liposomes) sufficiently covers the area

Consider the size of the surgical site and neuroanatomy to determine expansion volume

Examples of expansion volumes by TAP procedure

For early onset, admix with bupivacaine HCI

Example of admixing

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

Administration

Administer EXPAREL differently than bupivacaine HCl

Bupivacaine HCl is an aqueous solution

  • Readily diffuses into surrounding tissue and spreads throughout site
  • Requires fewer injections than EXPAREL for adequate pain-receptor coverage
  • Utilizes a consistent injection technique throughout the surgical site

EXPAREL is a suspension composed of multivesicular liposomes that carry bupivacaine

  • Stays precisely where placed; does not readily diffuse into surrounding tissue
  • Requires more injections than other local anesthetics to ensure adequate coverage

Proper local infiltration technique for optimal postsurgical pain control

Inject deep into the tissue vs surgical site

Surgical-site inflitration

  • Utilizing a moving needle technique, EXPAREL should be injected slowly (generally 1 to 2 mL per injection) with frequent aspiration to check for blood and minimize the risk of inadvertent intravascular injection
  • Infiltrate above and below fascia and into subcutaneous tissues
  • Aspirate frequently to minimize risk of intravascular injection
  • Use a 25-gauge or larger-bore needle to maintain the structural integrity of liposomes