Pain Control Tailored
to Your Patients’ Needs
Overview
EXPAREL Offers Flexible Dosing & Versatile Administration
Watch a Video of EXPAREL Dosing & Administration
Dosing
Adult Dosing
Local Infiltration
The recommended dose of EXPAREL for local infiltration in adults is up to a maximum dose of 266 mg, and is based on the following factors:
- Size of the surgical site
- Volume required to cover the area
- Individual patient factors that may impact the safety of an amide local anesthetic
The 266 mg (20 mL Vial) May Be Appropriate for*
- Abdominal/colorectal/general/urologic: abdominal wall reconstruction, bariatric, colectomy, hernia, nephrectomy
- Breast: mastectomy, breast reconstruction
- OB/GYN: C-section, hysterectomy, myomectomy
- Orthopedic: TKA, bunionectomy, THA, fracture repair, fusions
- Spine surgery: discectomy, fusions, laminectomy
- Fascial plane blocks: ESP, PECS I and II, QL, rectus sheath, TAP
*These are examples of procedures that may be appropriate for the above-referenced vial 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.
The 133 mg (10 mL Vial) May Be Appropriate for Small Anatomical Areas, Such As*
- Plastic surgery: rhinoplasty, face lift
- OMFS: tonsillectomy, orthognathic surgery
- Dental: implants, extractions
*These are examples of procedures that may be appropriate for the above-referenced vial 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.
OMFS, oral and maxillofacial surgery.
Nerve Blocks
The recommended dose of EXPAREL for nerve block in adults is 133 mg (10 mL).
Examples of nerve block procedures and respective dosing:
Interscalene Brachial Plexus
Nerve Block in Adults†
133 mg (10 mL)
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
Sciatic Nerve Block in the Popliteal Fossa in Adults§
133 mg (10 mL)
The safety and effectiveness of EXPAREL have not been established to produce postsurgical regional analgesia via other nerve blocks besides an interscalene brachial plexus nerve block, a sciatic nerve block in the popliteal fossa, or an adductor canal block.
†Recommendation based on study of patients undergoing rotator cuff repair or total shoulder arthroplasty.
‡Recommendation based on study of patients undergoing total knee arthroplasty.
§Recommendation based on study of patients undergoing bunionectomy.
Pediatric Dosing
Local infiltration: Pediatric dosing for EXPAREL is weight-based. 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.
Pediatric Dosing Calculator*
Select unit
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.
EXPAREL May Be Admixed 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 Vial) 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
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 133 mg (10 mL Vial) 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
- Avoid additional use of anesthetics within 96 hours following administration of EXPAREL
- Do not admix EXPAREL with any other agents or local anesthetics (eg, lidocaine) other than bupivacaine HCl
- Admixing may impact the pharmacokinetic and/or pharmacodynamic properties of EXPAREL; the effect is concentration-dependent
- The toxic effects of these drugs are additive, and their administration should be used with caution, including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity
*Bupivacaine HCl is indicated for use in patients aged 12 years and older.
Administration
Administration Technique Guidance
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. Arrow depicts needle and demonstrates the correct plane for placement of EXPAREL.
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. This dose recommendation is based on a study of patients undergoing shoulder surgery where the EXPAREL 133 mg was expanded with 10 mL of normal saline to a total volume of 20 mL
- 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 supine or semi-sitting position with the head turned away from the side that will be blocked
STEP 2:
Visualize the C5 and C6 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 beveled tip block needle into the plane from posterior-lateral to anterior-medial
- May confirm needle position using nerve stimulation and/or hydrodissection
- Deposit EXPAREL between the anterior and middle scalene muscles until the injection 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). This dose recommendation is based on a study of patients undergoing bunionectomy where the EXPAREL 133 mg was expanded with 20 mL of normal saline to a total volume of 30 mL. In this study, a Mayo block was also performed in all patients
- 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 or in lateral position with operative side up
STEP 2:
Visualize the Tibial Nerve (TN) and Common Peroneal Nerve (CPN)
- Use an ultrasound probe to identify the TN and CPN within the popliteal fossa
- 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 beveled tip block needle into the plane in a lateral to medial orientation, bypassing the CPN laterally until adjacent to the TN
- May confirm needle position using nerve stimulation and/or 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 the Nerve to Vastus Medialis (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 beveled tip block needle into the plane in an anterior medial to posterior lateral orientation and advance toward the NVM. Be careful not to injure the NVM with the needle path
- May confirm needle position using nerve stimulation and/or hydrodissection
- Slowly deposit 10 mL of the EXPAREL admixture around the NVM until adequate spread is achieved
- May scan proximal and distal to confirm adequate spread along sciatic nerve
- 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
MOA and Dosing & Administration
MOA, mechanism of action.
