Cost and Value

EXPAREL is available in 133 mg (10 mL) dose for $227.63 and 266 mg (20 mL) dose for $376.12. 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.

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Women's Health

Microvascular Breast Reconstruction: 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

In patients who received EXPAREL for analgesia

  • 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 days

    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 expanded 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 expanded 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

*All pain was measured using the visual analog scale.

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

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

ERAS, enhanced recovery after surgery; TRAS, traditional recovery after surgery; LOS, length of stay.

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