Nurse and patient smiling as patient is discharged from hospital post-nerve block surgery

Clinical and economic value outcomes with EXPAREL

Cost & Value

EXPAREL is available in 133 mg (10 mL) for $180.35 and 266 mg (20 mL) doses 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 length of stay (LOS). These, in turn, can lead to fewer patient complications and reduced hospital costs per patient.

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Women's Health

Microvascular Breast Reconstruction1: Medical center in Minnesota

Study Methods

  • 49 adult patients undergoing microvascular breast reconstruction with EXPAREL as part of an ERAS protocol compared with 51 adult patients undergoing microvascular breast reconstruction with TRAS before development of the ERAS protocol
  • Retrospective cohort study
  • Characteristics were compared between the 2 groups, and a multivariable regression analysis was used on continuous outcome variables to account for baseline differences between the 2 groups

Safety Outcomes

  • No significant differences between the 2 groups in relation to 30-day complications
    • The ERAS group experienced an increased incidence of native breast skin flap cellulitis compared with the group without ERAS (20% vs 6%, respectively; P=0.03)

Clinical and Economic Outcomes

Patients who received EXPAREL as part of ERAS
  • Significantly

    better pain control

    (P=0.02) 24 hours postsurgery*

    • 24 hours: 3.3 vs 4.1 (P=0.02)
  • 71%

    fewer total
    opioids used
    postsurgery (mg)

    • Total: 167.3 vs 574.3 (P<0.001)
    • Day 1: 67.3 vs 260.9 (P<0.001)
    • Day 2: 53.5 vs 192.2 (P<0.001)
    • Day 3: 39.0 vs 113.1 (P<0.001)
  • 1.6 day

    shorter LOS postsurgery

    • Total: 3.9 vs 5.5 days (P<0.001)
 

MICROVASCULAR RECONSTRUCTION WITH EXPAREL AS PART OF ERAS (n=49)

  • All procedures included use of EXPAREL diluted with saline and infiltrated as a subfascial TAP block into the rectus sheath(s) and into subcutaneous tissues at the lower abdominal incision
  • Local anesthesia or pain pump catheters were not used
  • Included 9 unilateral and 40 bilateral procedures

MICROVASCULAR RECONSTRUCTION WITH TRAS (n=51)

  • 5 procedures included use of EXPAREL prior to standardization of EXPAREL use as part of all ERAS procedures
    • EXPAREL was diluted with saline and infiltrated as a subfascial TAP block into the rectus sheath(s) and into subcutaneous tissues at the lower abdominal incision
  • Included use of local anesthesia and pain pump catheters
  • Included 10 unilateral and 41 bilateral procedures

ERAS, enhanced recovery after surgery; TRAS, traditional recovery after surgery.

*All pain was measured using the visual analog scale.

Parenteral and oral opioid intake was converted into oral morphine equivalents (mg) using standardized calculations.