Is EXPAREL® Right for My Patients?

EXPAREL is indicated for administration into the surgical site to produce postsurgical analgesia

  • Used in more than 3 million patients in numerous surgical procedures1
  • Please see Important Safety Information at the bottom of this page

Soft tissue

  • Abdominal
    • Hernia
    • Bariatric
    • Open and laparoscopic colorectal
    • Ileostomy reversal
    • Abdominal wall reconstruction
  • Anorectal
  • Breast
    • Mastectomy
  • Plastic surgery
    • Cosmetic: breast augmentation, breast reduction, abdominoplasty
  • Reconstructive
    • Plastic reconstructive
    • Abdominal wall
  • Female genitourinary
    • Hysterectomy
    • C-section
  • Male genitourinary
    • Prostatectomy
  • Transversus abdominis plane (TAP) block-based procedures

Orthopedic

  • Total knee arthroplasty
  • Total hip arthroplasty
  • Foot and ankle
  • Fusions, fractures

Spine

  • Discectomy
  • Sacral fusion
  • Lumbar fusion
  • Laminectomy
  • Posterior cervical fusion

Consider a multimodal pain management regimen to reduce the need for opioids

Approximately 95% of patients receive an opioid for postsurgical pain control2,*

  • Many of these patients report experiencing common opioid-related adverse events (ORAEs)
According to a national survey of 250 patients, in the 2-week period following a completed inpatient or outpatient procedure3,*:

41%

report drowsiness

28%

report nausea

26%

report constipation

21%

report vomiting

10%

report itching

8%

report difficulty urinating

  • Certain patients are more prone to experience ORAEs4-18
Patient type Risk of experiencing the following costly/severe ORAEs
Elderly Opioid-induced delirium, oversedation, respiratory depression4-7
Opioid-tolerant Hyperalgesia8,9
Obese/sleep apneic Respiratory depression4,10-12
Enlarged prostate/BPH Urinary retention13
Respiratory disorders (eg, COPD, asthma) Respiratory depression4,14

*Among patients who underwent hip replacement, lap cholecystectomy, lap colectomy, open colectomy, and total abdominal hysterectomy in a national retrospective analysis.

Click here to view the full Sentinel Event Alert from The Joint Commission that reviews potential issues with opiods.4

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

The Opioid Burden

Learn about postsurgical pain management and concerns regarding opioid use for pain.

​More

Administration Case Reports

Read how physicians are using EXPAREL in their practices.

More

EXPAREL in Oral Surgery

Find information on using EXPAREL for local infiltration in oral surgery.

More

Important Notice

This site is for informational purposes only and is intended to address medical questions from healthcare professionals in the United States.

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, submit a request to Medical Information or call 1-855-RX-EXPAREL (1-855-793-9727).

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

References

  1. Data on file. 2125. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; January 2017.
  2. Oderda GM, Gan TJ, Robinson SB. Opioid-related adverse events increase the length of stay and drive up total cost of care in a national database of postsurgical patients. Presented at the 46th American Society of Health System Pharmacists Midyear Clinical Meeting. New Orleans, LA; December 4-8, 2011.
  3. Apfelbaum JL, Chen C, Mehta SS, et al. Postoperative Pain Experience: Results from a National Survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540.
  4. The Joint Commission. Safe use of opioids in hospitals. The Joint Commission Sentinel Event Alert: August 8, 2012; Issue 49.
  5. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006;102(4):1255-1266.
  6. National Opioid Use Guideline Group (NOUGG). Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Canada: NOUGG: 2010. Nationalpaincentre.mcmaster.ca/opioid/. Accessed May 26, 2016.
  7. Wilder-Smith OH. Opioid use in the elderly. Eur J Pain. Apr 2005;9(2):137-140.
  8. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145-161.
  9. Rozen D, DeGaetano NP. Perioperative management of opioid-tolerant chronic pain patients. J Opioid Manag. 2006;2(6):353-363.
  10. Schug SA, Raymann A. Postoperative pain management of the obese patient. Best Pract Res Clin Anaesthesiol. 2011;25(1)73-81.
  11. Passannante AN, Rock P. Anesthetic management of patients with obesity and sleep apnea. Anesthesiol Clin North America. 2005;23(3):479-491.
  12. Ingrande J, Lemmens HFC. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16-i23.
  13. Verhamme KM, Sturkenboom MC, Stricker BH, Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf. 2008;31(5):373-388.
  14. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
  15. Oderda GM, Evans RS, Lloyd J, et al. Cost of opioid-related adverse drug events in surgical patients. J Pain Symptom Manage. 2003;25:276-283.
  16. Oderda GM, Said Q, Evans RS, et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother. 2007;41:400-406.
  17. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277(4):307-311.
  18. Asgeirsson T, El-Badawi KI, Mahmood A, et al. Postoperative ileus: it costs more than you expect. J Am Coll Surg. 2010;210:228-231.

Important Safety Information

Warnings and Precautions Specific to EXPAREL

Warnings and Precautions for Bupivacaine-Containing Products

Please refer to full Prescribing Information.

Important Safety Information

Medical Information

US healthcare professionals Click Here

Non-US healthcare professionals can submit a request to medinfo@pacira.com

If you are not a healthcare professional, please discuss any questions you have regarding your health or treatment with your physician, pharmacist, nurse, or other healthcare professional.

Important information about EXPAREL®

The FDA confirms that EXPAREL has always been approved for "administration into the surgical site to produce postsurgical analgesia" for use in a variety of surgeries not limited to those studied in its pivotal trials.

"We are pleased to announce a successful collaboration with the FDA to resolve this matter in an expeditious and meaningful way that allows us to get back to the important task at hand—reducing postsurgical opioid exposure by providing a non-opioid option like EXPAREL to as many patients as appropriate."

- Dave Stack, Chief Executive Officer and Chairman of Pacira

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

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia
  • In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting
  • EXPAREL is not recommended to be used in the following patient population: patients <18 years old and/or pregnant patients
  • 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

Warnings and Precautions Specific to EXPAREL

  • EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks, or intravascular or intra-articular use
  • 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. Formulations of bupivacaine other than EXPAREL should not be administered within 96 hours following administration of EXPAREL

Warnings and Precautions for Bupivacaine-Containing Products

  • Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesias. CNS reactions are characterized by excitation and/or depression
  • Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability which may lead to dysrhythmias sometimes leading to death
  • Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients
  • Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use

Please refer to full Prescribing Information.

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