Pain Control Tailored to Your Patients’ Needs
Overview
Dosing & Administration
EXPAREL is administered during surgery and offers versatile administration options that make it adaptable for a wide range of procedures.
Nerve blocks
Provide targeted, regional pain relief by blocking specific nerve pathways associated with the surgical area*
Field blocks
Deliver sustained analgesia to broader, superficial surgical regions, making them ideal for larger procedures
Local infiltration
Enables precise, site-specific pain relief
Volume expansion
Expand EXPAREL with saline to extend coverage for larger surgical sites
Since EXPAREL is administered differently than bupivacaine HCl, proper administration technique is critical for effective distribution of EXPAREL at the surgical site to optimize pain control.1
*EXPAREL is only approved for interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block
Dosing
Key Dosing Considerations With EXPAREL
EXPAREL is available in two doses: 266 mg (20 mL) and 133 mg (10 mL). To ensure optimal analgesic coverage, the volume should be expanded for larger surgical sites. To attain early analgesic onset, bupivacaine HCl can be administered immediately before EXPAREL or admixed in the same syringe as part of the total expanded volume.
Dosing for infiltration and field blocks with EXPAREL
| RECOMMENDED DOSE | BASED ON |
|---|
Local infiltration
| Adults | Maximum dose of 266 mg (20 mL) |
|
| Pediatric patients (aged 6 to less than 17 years) | 4 mg/kg (up to a maximum of 266 mg) | Weight |
Regional analgesia
| Interscalene brachial plexus nerve block in adults | 133 mg (10 mL) | Study of patients undergoing rotator cuff repair or total shoulder arthroplasty |
| Adductor canal block in adults | 133 mg (10 mL) admixed with 50 mg (10 mL) 0.5% bupivacaine HCl, for a total volume of 20 mL | Study of patients undergoing total knee arthroplasty |
| Sciatic nerve block in the popliteal fossa in adults | 133 mg (10 mL) | Study of patients undergoing bunionectomy |
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The 266 mg (20 mL) dose is
appropriate for*
- Abdominal/colorectal/general/urologic: abdominal wall reconstruction, bariatric, colectomy, hernia, nephrectomy
- Breast: mastectomy, breast reconstruction
- OB/GYN: C-section, hysterectomy, myomectomy
- Orthopedic: fusions/fractures, THA, TKA
- Spinal: discectomy, fusions, laminectomy
- Fascial plane blocks: ESP, PECS I and II, QL, rectus sheath, TAP
The 133 mg (10 mL) dose is appropriate for small anatomical areas, such as*
- Facial/plastic
- Oral/maxillofacial
- Upper extremity: interscalene brachial plexus nerve block
- Lower extremity: adductor canal block or sciatic nerve block in the popliteal fossa
*These are examples of procedures that typically require the above-referenced dose of EXPAREL. Please use your professional clinical judgment when determining the appropriate dose of EXPAREL for a given surgical procedure and refer to the full Prescribing Information before using.
C-section, cesarean section; ESP, erector spinae plane; OB/GYN, obstetrics/gynecology; PECS, pectoralis; QL, quadratus lumborum; RCR, rotator cuff repair; TAP, transversus abdominis plane; THA, total hip arthroplasty; TKA, total knee arthroplasty.
Pediatric dosing calculator*
The recommended infiltration dose for pediatric patients (aged 6 to less than 17 years) is 4 mg/kg, up to a maximum of 266 mg. Use the calculator below to determine the appropriate dose.
EXPAREL is indicated in patients aged 6 years and older for local analgesia via infiltration.
*This dose is recommended for local analgesia via infiltration in patients aged 6 years and older who typically require the referenced dose of EXPAREL. Please use your professional clinical judgment when determining the appropriate dose of EXPAREL for a given surgical procedure and refer to the full Prescribing Information before using.
Admix EXPAREL With Bupivacaine HCl* to Ensure Early Analgesic Onset
Bupivacaine HCl can be administered immediately before EXPAREL or admixed in the same syringe as part of the total expanded volume
Ensure ratio of milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2
Admixing bupivacaine HCl with 266 mg (20 mL) of EXPAREL
- 20 mL vial contains 266 mg of EXPAREL, which is equivalent to 300 mg of bupivacaine HCl
- 1:2 ratio allows 150 mg of bupivacaine HCl to 266 mg of EXPAREL
Admixing bupivacaine HCl with 133 mg (10 mL) of EXPAREL
- One 10 mL vial contains 133 mg of EXPAREL, which is equivalent to 150 mg of bupivacaine HCl
- 1:2 ratio allows up to 75 mg of bupivacaine HCI to 133 mg of EXPAREL
Important considerations for admixing
- Admixing may impact the pharmacokinetic and/or pharmacodynamic properties of EXPAREL; the effect is concentration-dependent
- Do not admix EXPAREL with any other agents or local anesthetics (eg, lidocaine) other than bupivacaine HCI
- Avoid additional use of anesthetics within 96 hours following administration of EXPAREL
*Bupivacaine HCl is indicated for use in patients aged 12 years and older
Administration
Administration Guidance for All Procedures
Surgical site infiltration
- Use a 25-gauge or larger-bore needle to maintain the structural integrity of the liposomal particles
- Inject slowly and deeply (generally 1-2 mL per injection) into the soft tissues using a moving needle technique (ie, inject while withdrawing the needle)
- Infiltrate above and below the fascia and into the subcutaneous tissue
- Inject frequently in small areas (1-1.5 cm apart) to ensure overlapping analgesic coverage
- Aspirate frequently to minimize the risk of intravascular injection
Fascial plane infiltration for regional field blocks
- Use a regional field block technique, such as ESP, PECS I and II, QL, RS, or TAP, for postsurgical regional analgesia
- Multiple blocks can be used in combination to achieve full coverage of the surgical site(s)
- Perform using ultrasound guidance or laparoscopic visualization to enable precise placement of EXPAREL within the plane
- Deposit EXPAREL within the musculofascial plane so that it can spread and provide sensory blockade to the nerve(s) contained within the anatomical plane
Sonoanatomy showing abdominal wall muscles and the needle direction for the lateral TAP block. The pool of EXPAREL mixture is seen in the correct plane.
ESP, erector spinae plane; PECS, pectoralis; QL, quadratus lumborum; RS, rectus sheath; TAP, transversus abdominis plane.
- The recommended dose of EXPAREL for ISBPNB in adults is 133 mg (10 mL) and is based on a study of patients undergoing either TSA or RCR
- Do not exceed maximum dose of 133 mg (10 mL)
- Administer EXPAREL with a 25-gauge or larger-bore needle to maintain the structural integrity of liposomal bupivacaine particles
STEP 1:
Locate the interscalene brachial plexus
- Place patient in the supine position, with the hip and knee slightly flexed and the hip externally rotated to allow access to the medial thigh
STEP 2:
Visualize the C5 to C7 nerve roots
- Place an ultrasound probe on the patient’s neck superior to the clavicle to identify the interscalene brachial plexus between the anterior and middle scalene muscles
STEP 3:
Perform ISBPNB with EXPAREL
- Insert a 20- to 22-gauge echogenic needle into the plane from lateral to medial until the tip is just lateral to the bottom of the interscalene brachial plexus
- Confirm needle position using nerve stimulation and hydrodissection
- Deposit EXPAREL between the anterior and middle scalene muscles until the infiltration around the brachial plexus is documented by ultrasound
ASM, anterior scalene muscle; C5 to C7, cervical nerve roots; DSN, dorsal scapular nerve; LCa, longus capitis; LTN, long thoracic nerve; MSM, middle scalene muscle; RCR, rotator cuff repair; SCM, sternocleidomastoid; TSA, total shoulder arthroplasty; VA, vertebral artery.
- The recommended dose of EXPAREL for sciatic nerve block in the popliteal fossa in adults is 133 mg (10 mL), expanded with 20 mL of normal saline to a total volume of 30 mL, and is based on a study of patients undergoing bunionectomy
- Do not exceed maximum dose of 133 mg (10 mL)
- Administer EXPAREL with a 25-gauge or larger-bore needle to maintain the structural integrity of liposomal bupivacaine particles
STEP 1:
Locate the popliteal fossa
- Place patient in the supine position, with the knee flexed and hip internally rotated to allow access to the posterior thigh and popliteal fossa
STEP 2:
Visualize the TN and CPN
- Use an ultrasound probe to identify the elements just above the popliteal fossa crease
- Move the probe proximally until the bifurcation of the TN and CPN is identified within the sciatic nerve sheath
STEP 3:
Perform sciatic nerve block in the popliteal fossa with EXPAREL
- Insert a 20- to 22-gauge needle into the plane in a lateral to medial orientation, bypassing the CPN laterally until adjacent to the TN
- Confirm needle position using nerve stimulation and hydrodissection
- Deposit EXPAREL slowly until adequate spread around the TN and CPN is achieved
BF, biceps femoris; CPN, common peroneal nerve; PA, popliteal artery; PV, popliteal vein; ST, semitendinosus; TN, tibial nerve.
- The recommended dose of EXPAREL for adductor canal block in adults is 133 mg (10 mL) admixed with 50 mg (10 mL) 0.5% bupivacaine HCl,* for a total volume of 20 mL, and is based on a study of patients undergoing total knee arthroplasty
- Do not exceed maximum dose of 133 mg (10 mL)
- Administer EXPAREL with a 25-gauge or larger-bore needle to maintain the structural integrity of liposomal bupivacaine particles
STEP 1:
Locate the adductor canal
- Place patient in the supine position, with the hip and knee slightly flexed and the hip externally rotated to allow access to the medial thigh
STEP 2:
Visualize the saphenous nerve and NVM
- Use a probe to identify the elements of the sartorius muscle and femoral artery and the vastus medialis allowing visualization of saphenous nerve and NVM
STEP 3:
Perform adductor canal block with EXPAREL
- Insert a 20- to 22-gauge needle into the plane in an anterior medial to posterior lateral orientation and advanced toward the NVM
- Confirm needle position using nerve stimulation and hydrodissection
- Slowly deposit 10 mL of the EXPAREL admixture around the NVM until adequate spread is achieved
- Reposition needle to the saphenous nerve, repeating the injection procedure for the remaining 10 mL of EXPAREL admixture
*Bupivacaine HCl is indicated for use in patients aged 12 years and older
FV, femoral vein; NVM, nerve to vastus medialis; SFA, superficial femoral artery; SM, sartorius muscle; SN, saphenous nerve; VM, vastus medialis.
EXPAREL Dosing & Administration Video
The broad indication of EXPAREL affords versatility of administration. Administer as surgical site infiltration to produce local analgesia, as a field block to produce regional analgesia, or in adults, as an interscalene brachial plexus nerve block.
Versatility of Administration
MOA and Dosing & Administration
EXPAREL administration training is led by experienced clinical educators and practicing providers, equipping surgeons and anesthesiologists with the techniques needed to deliver consistent, effective postsurgical pain relief.
