EXPAREL in orthopedic 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.

Ankle FracturePerformed by Dr Munz

For more information on EXPAREL, connect with us here

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

Ankle Fracture

Ankle Fracture Performed by Dr Munz

Bone-Patellar Tendon-Bone ACL Reconstruction

Bone-Patellar Tendon-Bone ACL Reconstruction Performed by Dr Barber

Bunionectomy

Bunionectomy Performed by Dr Parekh

Posterior Hip Arthroplasty

Posterior Hip Arthroplasty Performed by Dr Long

Left Unstable Intertrochanteric Hip Fracture Fixation

Left Unstable Intertrochanteric Hip Fracture Fixation Performed by Dr Amin

Quad Tendon ACL Arthroscopic Reconstruction

Quad Tendon ACL Arthroscopic Reconstruction Performed by Dr Sigman

Total Hip Arthroplasty, Modified Hardinge Antero-Lateral Approach

Total Hip Arthroplasty, Modified Hardinge Antero-Lateral Approach Performed by Dr Guevara

Total Hip Arthroplasty - Anterior Approach

Total Hip Arthroplasty - Anterior Approach Performed by Dr Sah

Total Knee Arthroplasty

Total Knee Arthroplasty Performed by Dr Dysart

Clinical data support the use of EXPAREL

  • The PILLAR study assessed the safety and effectiveness of EXPAREL vs bupivacaine HCI in total knee arthroplasty (TKA) using standardized volume, technique, and protocol, which included opioid-minimizing multimodal pain management in both the study and control groups.

    Read the publication

Multimodal protocol and results: TKA

Study design1

Phase 4, multicenter, randomized, double-blind, controlled, parallel-group study comparing the safety and efficacy of infiltration of EXPAREL (n=70) versus standard bupivacaine (n=69) in adults undergoing primary unilateral TKA.

Multimodal protocol

PREOPERATIVE

  • Celecoxib 200 mg orally
  • Acetaminophen 1000 mg orally
  • Pregabalin 300 mg orally

INTRAOPERATIVE

  • Both groups:
    • Fentanyl (or fentanyl analogs)
    • Spinal anesthesia
  • EXPAREL group:
    • EXPAREL 266 mg/20 mL + 0.5% bupivacaine HCl 20 mL + saline 80 mL
  • Bupivacaine HCl group:
    • 0.5% bupivacaine HCl 20 mL + saline 100 mL

POSTSURGICAL

  • Celecoxib 200 mg orally every 12 hours until discharge
  • Acetaminophen 975 mg to 1000 mg orally every 8 hours (maximum of 3000 mg/day)
  • Immediate-release oxycodone ≤10 mg orally every 4 hours (maximum) or as needed; if oral therapy was not tolerated, morphine 2.5 to 5 mg intravenously or hydromorphone 0.5 to 1 mg intravenously every 4 hours or as needed

Patients who received multimodal analgesia with EXPAREL

Less Pain
  • 180.8 vs 209.3 cumulative AUC of VAS 12 to 48 hours after surgery (P=0.0381)
Fewer opioids*†
  • 18.7 mg vs 84.9 mg 0 to 48 hours (P=0.0048)
More opioid free
  • 10% vs 0% in the first 72 hours (P=0.01)

*Opioid intake measured in MED (mg).

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

AUC, area under the curve; MED, morphine equivalent dosing; TKA, total knee arthroplasty; VAS, visual analog scale.

Multimodal protocol and results: THA

Study design2

Retrospective study comparing the efficacy of standard THA pain management with adjunct EXPAREL (n=586) versus standard THA pain management alone (n=686) in patients undergoing THA.

Multimodal protocol

PREOPERATIVE

  • Celecoxib 200 mg orally
  • Acetaminophen 1000 mg orally
  • Pregabalin 50 mg orally

INTRAOPERATIVE

  • Both groups:
    • Spinal (preferred) or general (alternate) anesthesia
    • Injection of bupivacaine HCl + epinephrine 0.25% 40 mL,* morphine sulfate (1 mg/mL) 5 mL, and ketorolac (30 mg/mL) 1 mL
  • THA + EXPAREL group:
    • Periarticular injection of EXPAREL 266 mg/20 mL in 0.9% saline 40 mL
  • THA group:
    • No EXPAREL administered

POSTSURGICAL

  • Patient-controlled analgesia for up to 24 hours after surgery
  • Oral opioids as needed
  • Morphine/hydromorphone HCI intravenously as needed for breakthrough pain

Patients who received multimodal analgesia with EXPAREL

Significant pain reduction
  • 8 hours after surgery (P=0.031)
Fewer opioids used
  • POD 1 (P=0.001)
  • POD 2 (P=0.016)
Achieved more physical therapy milestones
  • Gait: 82% vs 64% (P<0.001)
  • Stairs: 93% vs 76% (P<0.001)

*The use of EXPAREL in combination with epinephrine is not part of the approved label.

Opioid intake measured in MED (mg).

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

AUC, area under the curve; MED, morphine equivalent dosing; THA, total hip arthroplasty; VAS, visual analog scale.

Multimodal protocol and results: TKA and THA

Study design3

Retrospective chart review that analyzed the outcome and feasibility of same-day discharge using an ERAS protocol in the inpatient setting in Medicare patients undergoing TKA (n=337) or THA (n=308).

Multimodal protocol

  • Patients were required to have a friend or family member who could assist with nonsurgical care and provide support on the day of surgery and for 3 days after surgery, in order to maintain adherence with medication, exercise, and analgesia protocols
  • Patients and their assistants were educated on realistic pain expectations, dangers related to opioid use, opioid tapering, sleep hygiene, exercise and walking programs, walker safety, wound care, and home preparation
  • Individualized preoperative opioid analgesia protocol
  • Non-opioid analgesia protocol consisting of acetaminophen, meloxicam, or celecoxib utilized 1 week before surgery and for 6 weeks after surgery
  • Spinal anesthesia
  • Periarticular infiltration with EXPAREL 266 mg/20 mL, bupivacaine HCl, and adjuncts
  • THA-specific protocol
  • Anterior lateral femoral cutaneous nerve field block with EXPAREL 266 mg/20 mL and bupivacaine HCl
  • TKA-specific protocol
  • Adductor canal block with bupivacaine HCl
  • Restricted intravenous opioids during surgery

Patients who received multimodal analgesia with EXPAREL

Same-day discharge
  • 84% of patients were discharged on the day of surgery
Hight pain management satisfaction
  • 98.3% of patients were “very much” or a “good amount” satisfied with their pain management
Postsurgical opioids use*
  • 84.2% of patients did not require an opioid prescription beyond the initial 7-day prescription provided at discharge

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

ERAS, enhanced recovery after surgery; THA, total hip arthroplasty; TKA, total knee arthroplasty.