EXPAREL in breast surgery

Administration volume and technique are critical to achieving optimal results

The videos below include a variety of surgical procedures that demonstrate examples of how to administer EXPAREL for optimal pain control and coverage.

Mastectomy With Breast Reconstruction Performed by Dr Brzezienski

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This video represents an individual clinician experience with and methodology for using EXPAREL.

Pacira BioSciences, Inc., recognizes that there are other methodologies for administering local anesthetics, as well as individual patient considerations, when selecting the dose for a specific procedure.

Please see Important Safety Information below and refer to the Full Prescribing Information.

More Videos

Mastectomy With Breast Reconstruction

Mastectomy With Breast Reconstruction Performed by Dr Brzezienski

Bilateral Mastectomy With Breast Reconstruction

Bilateral Mastectomy With Breast Reconstruction Performed By Dr Herbstman

Multimodal approaches with or without ERAS protocols have demonstrated benefits in breast surgeries

Protocol implementation can positively impact recovery1

  • 35% shorter LOS2
  • 71% decrease in opioid use1
  • No reported increase in pain or complications2

Multimodal protocols and results: microsurgical breast reconstruction

Study design3

Retrospective analysis comparing an ERP with PCA of ketorolac and an EXPAREL TAP block (n=42) with historical controls (n=49) in patients undergoing deep inferior epigastric perforator or free transversus rectus abdominis myocutaneous flap breast reconstruction.

Multimodal protocol

INTRAOPERATIVE

  • Bilateral TAP block with EXPAREL 266 mg/20 mL expanded with saline 180 mL
  • Acetaminophen intravenously
  • Ketorolac intravenously
  • General anesthesia

POSTSURGICAL

  • PACU
    • Ketorolac 15 mg intravenously every 6 hours for 3 days
    • No intravenous PCA
    • Provision of oral or intravenous opioids for breakthrough pain
  • POD 1
    • Ketorolac 15 mg orally as needed after intravenous regimen

Patients who received multimodal analgesia with EXPAREL

Fewer opioids used*†
  • 46.0 mg vs 70.5 mg (P=0.003)
Shorter LOS
  • 4.0 days vs 5.0 days (P<0.001)

*Opioid intake measured in MED (mg).

TThe clinical benefit of the decrease in opioid consumption was not demonstrated in the pivitol trials.

ERP, enhanced recovery pathway; LOS, length of stay; MED, morphine equivalent dosing; PACU, postanesthesia care unit; PCA, patient-controlled analgesia; POD, postoperative day; TAP, transversus abdominis plane.

Multimodal protocols and results: microvascular breast reconstruction

Study design1

Retrospective study comparing the efficacy of EXPAREL as a TAP block and local infiltration as part of an ERAS pathway (n=49) with a historical cohort of patients who received traditional care after surgery (n=51).

Multimodal protocol

PREOPERATIVE

  • Celecoxib orally
  • Acetaminophen orally
  • Gabapentin orally

INTRAOPERATIVE

  • Bilateral TAP block and local infiltration with EXPAREL 266 mg/20 mL expanded with normal saline

INTRAOPERATIVE

  • Celecoxib and acetaminophen as needed; oral opioids as needed for rescue

Patients who received multimodal analgesia with EXPAREL

Fewer opioids used*†
  • 167.3 mg vs 574.3 mg (P<0.001)
Shorter LOS
  • 3.9 days vs 5.5 days (P<0.001)

*Opioid intake measured in MED (mg).

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

MED, morphine equivalent dosing; TAP, transversus abdominis plane; ERAS, enhanced recovery after surgery; LOS,length of stay.

The Breast Reconstruction Advisory Group and ERAS Society support the use of opioid-minimizing pain management strategies

  • “The authors propose an opioid-sparing multimodal analgesic clinical pathway for 4 common breast procedures…”4

    - Breast Reconstruction Advisory Group, 2015 Guidelines
  • “Strong recommendation for the use of multimodal opioid-sparing postsurgical pain management regimens, noting that ‘a single injection of liposomal bupivacaine lasts for several days, potentially avoiding the need for catheter-based infusions.’”5

    - ERAS Society, Breast Reconstruction 2017

ERAS, enhanced recovery after surgery.