EXPAREL is approved for use in interscalene brachial plexus nerve block

EXPAREL can help reduce or eliminate the use of opioids for acute postsurgical pain

EXPAREL has multiple indications for the treatment of your patients

  • Efficacy
  • Safety
  • Dosing and Administration
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Efficacy

Significant postsurgical pain relief that lasts 48 hours with EXPAREL in shoulder surgery

Visual analog scale (VAS) pain intensity scores with interscalene brachial plexus nerve block1
  • Primary end point was area under the curve (AUC) of the VAS pain intensity scores; 136 vs 254 (LSMD -118) for EXPAREL and placebo, respectively1

LSMD, least squares mean difference.

Results from a phase 3, double-blind, randomized, controlled trial that compared the postsurgical analgesia efficacy, safety, and pharmacokinetics of EXPAREL 133 mg (10 mL) and placebo in patients undergoing total shoulder arthroplasty or rotator cuff repair. Primary and secondary end points pain intensity through 48 hours postsurgery, as measured by AUC of VAS pain intensity scores and total postsurgical opioid consumption. Rescue opioids for pain were available upon patient request.1

78% reduction in opioids through 48 hours

Postsurgical opioid consumption through 72 hours2
  • The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials

More patients were opioid free with EXPAREL

Opioid-free patients1

EXPAREL significantly delays the time to rescue opioids

Time to rescue opioids1
  • The median time to rescue medication was over 4 hours with EXPAREL vs just over a half hour with placebo (P<0.0001)
    • The rescue medication given upon request was oral immediate-release oxycodone ≤10 mg every 4 hours or as needed

Safety

Non-opioid EXPAREL has a proven safety profile

Overall adverse events and most common treatment-emergent adverse events

≥5% of patients in the EXPAREL 133 mg or placebo group experienced treatment-emergent adverse events1*

EXPAREL provided sustained sensory block without prolonged motor block3

  • Median time to return of sensory function with EXPAREL was 36 hours, which was significantly longer than placebo (P<0.0001)
  • Median time to return of motor function was 24 hours with both EXPAREL and placebo

EXPAREL delivers bupivacaine in a consistent low dose over time

Plasma levels of bupivacaine released over 96 hours in an interscalene brachial plexus nerve block trial1
  • At the maximum recommended dose of EXPAREL for interscalene brachial plexus nerve block (133 mg), plasma levels of bupivacaine remain below toxicity thresholds (Cmax=207 ng/mL)4-6

Toxicity thresholds for bupivacaine HCI

  • The thresholds for central nervous system and cardiac effects are 2000 ng/mL and 4000 ng/mL, respectively4,7

Dosing

EXPAREL 133 mg (10 mL) in a single shot can help meet the demands of your practice and institution

    Convenience
  • The simplicity of a single dose that provides long-lasting pain control
  • No need for catheters and pumps that take time to insert and could interfere with patient recovery
    Flexibility
  • Appropriate for use in both inpatient and outpatient settings

Dosing guidance for EXPAREL in a single shot

The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL)

  • Based on one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair

EXPAREL can be admixed with bupivacaine HCl to expand its volume. See below for more guidance

Adminster EXPAREL with a 25-gauge or a larger bore needle

Administration precautions

  • If EXPAREL and other non-bupivacaine local anesthetics, including lidocaine, are administered at the same site, there may be an immediate release of bupivacaine from EXPAREL. Therefore, EXPAREL may be administered to the same site 20 minutes after injecting lidocaine. Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL

Admixing with bupivacaine HCI: Maintain a 1:2 ratio of bupivacaine HCl to EXPAREL

  • Bupivacaine HCI can be administered immediately before EXPAREL or admixed in same syringe, as long as the ratio of the milligram dose of bupivacaine HCI to EXPAREL does not exceed 1:2
  • Keep a 1:2 ratio of the milligram dose of bupivacaine HCI to EXPAREL
    • One 10 mL vial contains 133 mg, which is equivalent to 150 mg bupivacaine HCI
    • 1:2 ratio allows 75 mg bupivacaine HCI to 133 mg EXPAREL
  • Do not admix EXPAREL with any other agents prior to administration

ISBP, interscalene brachial plexus.

Cmax, maximum serum concentration; ISBP, interscalene brachial plexus.

ISBP, interscalene brachial plexus.