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days to go: ASP+6% CMS reimbursement for proven non-opioids used in all outpatient surgical settings is coming January 1, 2025.

ERAS and multimodal protocols with EXPAREL improve postsurgical outcomes*

ERAS protocols are multimodal pathways for comprehensive perioperative care that help make early recovery after surgery possible by supporting preoperative organ function and reducing postsurgical stress1

  • ERAS protocols have been shown to reduce complications and morbidity rate as well as generate cost savings2,3
  • One of the key elements in ERAS protocols is use of multimodal pain management strategies to minimize opioid-based postsurgical pain control4

Evidence is growing that the addition of EXPAREL to ERAS protocols improves postsurgical outcomes for a variety of surgical procedures:

  • Hernia repair5
  • Breast reconstruction6
  • Lumpectomy7
  • Liver surgery8
  • Abdominal wall reconstruction9
  • Nephrectomy10
  • Thoracotomy11
  • Spinal surgery12
  • C-section13
  • TKA (total knee arthroplasty)14

*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.

Enhanced recovery protocols with multimodal analgesia reduce opioid consumption, ORAEs, and improve recovery outcomes15

flask

Reduce pain16

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Minimize ORAEs17

hospital icon

Reduce discharge time18

surgical mask

Decreased costs19

ORAE, opioid-related adverse event.

ERAS pathways accelerate postoperative recovery and reduce general morbidity by simultaneously applying multiple interventions based on evidence20

ERAS is designed to:

  • Attenuate patient stress21
  • Reduce complications and LOS22
  • Facilitate (early) postsurgical recovery21
  • Maintain preoperative bodily compositions
    and organ function21
  • Reduce variability22
  • Maintain physiologic function21
  • Integrate throughout the perioperative pathway22
  • Increase value by reducing cost and improving
    quality of care21,22

LOS, length of stay.

ASP, average sales price; CMS, Centers for Medicare and Medicaid Services.

Important Notice

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.

References

  1. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5(5):342-348.
  2. Pache B, Joliat G-R, Hübner M, et al. Cost-analysis of enhanced recovery after surgery (ERAS) program in gynecologic surgery. Gynecol Oncol. 2019;154(2):388-393.
  3. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531-1541.
  4. Ljungqvist O, Scott M, Fearon KS. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292-298.
  5. Majumder A, Fayezizadeh M, Neupane R, Elliott HL, Novitsky Y. Benefits of Multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg. 2016;222(6):1106-1115.
  6. Batdorf NJ, Lemaine V, Lovely JK, et al. Enhanced recovery after surgery in microvascular breast reconstruction. J Plast Reconstr Aesthet Surg. 2015;68(3):395-402.
  7. Rojas KE, Manasseh D-M, Flom PL, et al. A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat. 2018;171(3):621-626.
  8. Day RW, Cleeland CS, Wng XS, et al. Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg. 2015;221(6):1023-1030.
  9. Fayezizadeh M, Petro CC, Rosen MJ, Novitsky YW. Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg. 2014;134(4 suppl 2):151S-159S.
  10. Rege A, Leraas H, Vikraman D, et al. Could the use of an enhanced recovery protocol in laparoscopic donor nephrectomy be an incentive for live kidney donation? Cureus. 2016;8(11):e889.
  11. Van Haren RM, Mehran RJ, Mena GE, et al. Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer. Ann Thorac Surg. 2018;106(1):272-279.
  12. Wang MY, Chang P-Y, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411-418.
  13. Nedeljkovic SS, Kett A, Vallejo MC, et al. Transversus abdominis plane block with liposomal bupivacaine for pain after Cesarean delivery in a multicenter, randomized, double-blind, controlled trial [published online ahead of print July 21, 2020]. Anesth Analg.
  14. Van Horne A, Van Horne J. Patient-optimizing enhanced recovery pathways for total knee and hip arthroplasty in Medicare patients: implication for transition to ambulatory surgery centers. Arthroplast Today. 2019;5(4):497-509.
  15. Elkassabany NM, Wang A, Ochroch J, Mattera M, Liu J, Kuntz A. Improved quality of recovery from ambulatory shoulder surgery after implementation of a multimodal perioperative pain management protocol. Pain Med. 2019;20(5):1012-1019.
  16. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician. 2001;63(10):1979-1984.
  17. Gandhi K, Viscusi E. Multimodal  pain management techniques in hip and knee arthroplasty. J NYSORA. 2009;13:1-10.
  18. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5 Suppl):S5-S22.
  19. Kim J, Burke SM, Kryzanski JT, et al. The role of liposomal bupivacaine in reduction of postoperative pain after transforaminal lumbar interbody fusion: a clinical study. World Neurosurg. 2016;91:460-467.
  20. Varadhan KK, Neal KR, Dejong CHC, Fearson KCH, Ljungqvist O, Lobo DN.. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-440.
  21. Miller TE, Gan TJ, Thacker JKM. Enhanced recovery pathways for major abdominal surgery. Anesth News. 2014:1-8.
  22. Miller TE, Thacker JK, White WD, et al; Enhanced Recovery Group. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052-1061.
SEE MORE

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.

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