EXPAREL is a cost-effective option for postsurgical pain management in the hospital and ambulatory (outpatient) settings

Cost and Value

EXPAREL is available in 133 mg (10 mL) dose for $180.35 and 266 mg (20 mL) dose for $334.18. The 133 mg (10 mL) and 266 mg (20 mL) doses of EXPAREL are available in cartons of 4 and 10 vials. For more information please visit How to order EXPAREL.

Information below helps review the value of EXPAREL in a multimodal pain management protocol that can lead to fewer opioids,* better pain control, and shorter LOS. These, in turn, can lead to fewer patient complications and reduced hospital costs per patient.

Cesarean Section: Medical center in Texas

Study Methods

  • Adult patients (N=201) who underwent elective, unscheduled waiting list, or emergency cesarean delivery with an EXPAREL TAP block (n=101) compared with patients who did not receive an EXPAREL TAP block (n=100)
  • Retrospective chart review

Safety Outcomes

  • Patients treated with EXPAREL reported fewer adverse events, such as nausea, vomiting, or pruritus (34% vs 50%; P=0.026)

Clinical and Economic Outcomes

In patients who received EXPAREL for analgesia

  • Significantly

    better pain control

    (P<0.001)

    • 132.8 vs 246.3 (P<0.001) of total AUC of NRS pain scores from 0 to 3 days
  • 47%

    reduction in postsurgical opioid consumption through 3 days§

    • Total postsurgical opioid consumption (MED), mg: 41.9 vs 79.6 (P<0.001)
  • 1 Day

    shorter LOS

    • 26% reduction in LOS (2.9 days vs 3.9 days; P<0.001)
    • 19% reduction in time to discharge readiness (2.9 days vs 3.6 days; P=0.006)
  • 15%

    reduction in PACU discharge readiness time (25 minutes)

    • 138 minutes vs 163 minutes (P=0.028)
  • 39%

    reduction in time to ambulation

    • 18.7 hours vs 30.7 hours; P<0.001
 

MULTIMODAL PROTOCOL (n=100)

  • Spinal-epidural anesthesia with intrathecal morphine and supplemental IV analgesia
  • Supplemental analgesia was based on patient reported pain scores
    • NRS 1 to 5: 3 doses of IV acetaminophen 10 mg/mL (15 mg/kg if body weight <50 kg) every 6 hours alternating with 3 doses of IV ketorolac 30 mg every 6 hours for 24 hours
    • NRS 6 to 10: IV nalbuphine 2 mg every 2 hours as needed for breakthrough pain for 24 hours

MULTIMODAL PROTOCOL WITH EXPAREL TAP BLOCK (n=101)

  • Ultrasound-guided TAP block with EXPAREL 266 mg/20 mL admixed with 30 mL of bupivacaine HCl 0.25% and 30 mL of normal saline, equaling 40 mL injected on each side (total volume: 80 mL)
  • Spinal-epidural anesthesia with intrathecal morphine and supplemental IV analgesia
  • Supplemental analgesia was based on patient reported pain scores
    • NRS 1 to 5: 3 doses of IV acetaminophen 10 mg/mL (15 mg/kg if body weight <50 kg) every 6 hours alternating with 3 doses of IV ketorolac 30 mg every 6 hours for 24 hours
    • NRS 6 to 10: IV nalbuphine 2 mg every 2 hours as needed for breakthrough pain for 24 hours

*The NRS scale used ranged from 0, representing no pain, to 10, representing the worst possible pain.

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

AUC, area under the curve; NRS, numerical rating scale; TAP, transversus abdominis plane; LOS, length of stay; MED, morphine equivalent doses; PACU, postanesthesia care unit.