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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
Recommended Dose
Maximum dose of 266 mg (20 mL)Based on
- Size of the surgical site
- Volume required to cover the area
- Individual patient factors that may impact the safety of an amide local anesthetic
Pediatric patients
(aged 6 to less than 17 years)
Recommended Dose
4 mg/kg (up to a maximum of 266 mg)Based on
WeightRegional analgesia
Interscalene brachial plexus nerve block in adults
Recommended Dose
133 mg (10 mL)Based on
Study of patients undergoing rotator cuff repair or total shoulder arthroplastyAdductor canal block in adults
Recommended Dose
133 mg (10 mL) admixed with 50 mg (10 mL) 0.5% bupivacaine HCl, for a total volume of 20 mLBased on
Study of patients undergoing total knee arthroplastySciatic nerve block in the popliteal fossa in adults
Recommended Dose
133 mg (10 mL)Based on
Study of patients undergoing bunionectomy
The 266 mg (20mL) 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
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;
*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.
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
- 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
- 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.
Expand EXPAREL to ensure optimal analgesic coverage for larger surgical sites
- Sufficient multivesicular liposomes must be available at the pain receptors to continuously release bupivacaine, ensuring long-lasting analgesia
- Consider the size, vascularity, and neuroanatomy of the surgical site
- Expand the volume to disperse liposomes throughout the surgical site
- Use normal saline (0.9%) or lactated Ringer’s solution
- Maintain a minimum concentration of 0.89 mg/mL
EXPAREL unexpanded
EXPAREL expanded
Consider the amount of EXPAREL, bupivacaine HCl,* and normal saline or lactated Ringer’s solution as part of the total maximum volume
Compatibility factors
- EXPAREL should not be admixed with local anesthetics other than bupivacaine prior to administration
- Wait 20 minutes after administering lidocaine or other non–bupivacaine-based local anesthetics before administering EXPAREL into the same surgical site
- Allow topical antiseptics to dry before administering EXPAREL into the same surgical site
- Do not dilute EXPAREL with water or other hypotonic agents, as it will result in disruption of the liposomal particles
*Bupivacaine HCl is indicated for use in patients aged 12 years and older.
ASP, average sales price; CMS, Centers for Medicare and Medicaid Services.
Important Notice
- This site is intended to provide medical and product information to health care professionals in the United States.
- To report an adverse event, email drugsafety@pacira.com or call 1-855-793-9727.
- For medical inquiries related to EXPAREL, submit a request to Medical Information or call 1-855-793-9727.
- These are not all of the potential important safety considerations for EXPAREL; please see the full Prescribing Information.
Indication
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.
Important Safety Information
- EXPAREL is contraindicated in obstetrical paracervical block anesthesia.
- Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation.
- Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia.
- Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine.
- EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, 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.
Warnings and Precautions Specific to EXPAREL
- Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL.
- EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block, or intravascular or intra-articular use.
- The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials.
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 paresthesia. 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.
- Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.
Please refer to full Prescribing Information.
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EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration
