Administration technique: critical for success
- Inject EXPAREL slowly into soft tissues of the surgical site using a deep tissue infiltration technique with frequent aspiration to check for blood and minimize the risk of intravascular injection
- Administer EXPAREL with a 25-gauge or larger-bore needle
- Rate of absorption and onset of action of EXPAREL may vary based on vascularity of the tissue, patient factors, timing of administration, and administration technique
- Bupivacaine HCl can be used with or immediately prior to EXPAREL to provide early analgesia coverage
Administering EXPAREL with bupivacaine HCl
- Bupivacaine HCl may be administered immediately before EXPAREL or admixed in the same syringe, as long as the ratio of the milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2
- In determining this ratio, consider the following:
- One 20 mL vial of EXPAREL contains 266 mg of free base bupivacaine; 266 mg of free base bupivacaine is molar equivalent to 300 mg of bupivacaine HCl
- One 30 mL vial of 0.5% bupivacaine contains 150 mg bupivacaine HCl
- Admixing may impact the pharmacokinetic and/or physiochemical properties of EXPAREL, and this effect is concentration dependent
- The toxic effects of these drugs are additive and their administration should be used with caution, including monitoring for neurological and cardiovascular effects related to toxicity
Transversus abdominis plane (TAP) block administration
Illustration courtesy of Admir Hadzic, MD, PhD.
EXPAREL infiltration and distribution
Technique and distribution are important when administering into the surgical site
- Inject EXPAREL slowly into the soft tissue of the surgical site using a deep-tissue infiltration technique
- Administer EXPAREL with a 25-gauge or larger-bore needle
- EXPAREL is best administered using a series of injections to effectively cover the surgical area since it does not diffuse throughout tissues in the same manner as traditional bupivacaine
- Because EXPAREL utilizes DepoFoam® technology and stays more precisely where placed, it requires more injections to cover the same area than would be needed with non-liposomal bupivacaine
EXPAREL stays more precisely where placed, requiring more injections to cover the same area
This site is for informational purposes only and is intended to address medical questions from healthcare professionals in the United States.
To report an adverse event, e-mail firstname.lastname@example.org
or dial 1-855-RX-EXPAREL (1-855-793-9727).
For medical inquiries related to EXPAREL, to Medical Information or call 1-855-RX-EXPAREL (1-855-793-9727).
These are not all of the potential important safety considerations for EXPAREL; please see the full Prescribing Information.
Non-US healthcare professionals can submit a request to email@example.com
If you are not a healthcare professional, please discuss any questions you have regarding your health or treatment with your physician, pharmacist, nurse, or other healthcare professional.
Important information about EXPAREL®
The FDA confirms that EXPAREL has always been approved for "administration into the surgical site to produce postsurgical analgesia" for use in a variety of surgeries not limited to those studied in its pivotal trials.
"We are pleased to announce a successful collaboration with the FDA to resolve this matter in an expeditious and meaningful way that allows us to get back to the important task at hand—reducing postsurgical opioid exposure by providing a non-opioid option like EXPAREL to as many patients as appropriate."
- Dave Stack, Chief Executive Officer and Chairman of Pacira
The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.
Important Safety Information
- EXPAREL is contraindicated in obstetrical paracervical block anesthesia
- In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting
- EXPAREL is not recommended to be used in the following patient population: patients <18 years old and/or pregnant patients
- Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations
Warnings and Precautions Specific to EXPAREL
- EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks, or intravascular or intra-articular use
- Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Formulations of bupivacaine other than EXPAREL should not be administered within 96 hours following administration of EXPAREL
Warnings and Precautions for Bupivacaine-Containing Products
- Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesias. CNS reactions are characterized by excitation and/or depression
- Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability which may lead to dysrhythmias sometimes leading to death
- Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients
- Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use
Please refer to full Prescribing Information.