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.

Abdominally Based Microsurgical Breast Reconstruction1: Medical center in New York

Study Methods

  • 128 adult patients undergoing breast reconstruction using abdominally based free flaps with or without a non-narcotic protocol using intraoperative TAP blockade. Patients were divided into a control group, a TAP catheter group, and a TAP EXPAREL group
  • Retrospective observational study
  • Primary and secondary outcomes were assessed for associations and adjusted for confounding variables

Safety Outcomes

  • The overall complication rate was 8.7%, with no significant differences between the groups
    • The TAP catheter group noted higher rates of transfusions (P=0.0084)

Clinical and Economic Outcomes

Patients who received EXPAREL to manage pain after surgery

  • Fewer total opioids used

    postsurgery vs catheter and control groups (mg)*

    • Day 0–1: 1.88 vs 7.25 (P=0.0081) vs 52.86 (P<0.0001)
    • Day 2: 2.12 vs 5.17 (P=0.0270) vs 29.9 (P=0.0009)
    • Day 3: 2.23 vs 3.60 (P=0.2157) vs 16.0 (P<0.0075)
  • 0.9 to

    1.4 days

    shorter LOS

    • EXPAREL group: 2.65 days
    • TAP catheter group: 3.52 days
    • Control group: 4.05 days
 

BREAST RECONSTRUCTION WITH TAP EXPAREL (n=40)

  • 15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
    • After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
  • A mixture of 20 mL of 1.3% EXPAREL, 30 mL of standard bupivacaine, and 80 mL of normal saline infiltrated at 30 mL into each side
    • The remainder of the mixture was infiltrated into the lower abdominal incision, pectoralis major muscle near the anastomotic site, superficial serratus plane, and drain sites

BREAST RECONSTRUCTION WITH TAP CATHETER (n=48)

  • 15 mg of IV ketorolac and 1000 mg of IV acetaminophen at the end of surgery and then every 6 hours postsurgery
    • After tolerance of an oral diet, patients switched to an oral regimen of 10 mg of ketorolac and 650 mg of acetaminophen, with oral opioids as needed for breakthrough pain
  • 30 mL of 0.25% bupivacaine injected bilaterally, followed by transcutaneous passing of bilateral epidural catheters into the plane and connected to a 400-mL capacity fixed-rate pump filled with 0.25% bupivacaine delivered through each catheter at 2 mL per hour

BREAST RECONSTRUCTION WITH NARCOTIC-BASED ANALGESIA CONTROL GROUP (n=40)

  • Standard narcotic-based analgesia regimen without locoregional anesthesia
  • IV PCA opioid pump with additional nurse-administered opioids for breakthrough pain, followed by transition to an as-needed oral opioid

TAP, transversus abdominis plane.

*Opioid consumption was measured using IV morphine equivalent (mg).