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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.

Avoid the burden of pumps and catheters with EXPAREL

Only EXPAREL provides long-lasting pain control in a single dose.

EXPAREL avoids the common problems associated with pumps and catheters1-4

  • Migration1
  • Unpredictability/malfunction2-4
  • Patient compliance2
  • Leakage2,3
  • Infection3

Why risk toxicity with pumps and catheters?

pMVL provides a sustained release of bupivacaine over time, maintaining plasma levels below toxic thresholds in various nerve blocks5-7

Systemic plasma bupivacaine concentration, ng/mL
  • EXPAREL 133 mg (ISBPNB) - Adult
  • EXPAREL 133 mg + Bupi HCl (100 mg) as Mayo Block (Popliteal NB)
  • Bupivacaine via continuous catheter femoral nerve block + local inifiltration (total 1210 mg of bupivacaine)
risk toxicity graph

Mean Cmax

209.35 ng/mL5

EXPAREL 133 mg ISBPNB

381.62 ng/mL7

EXPAREL 133 mg Sciatic Popliteal Block

  • Systemic plasma levels of bupivacaine following administration of LB are not correlated with local efficacy
  • The rate of systemic absorption of bupivacaine is dependent upon the total dose of drug administered, the route of administration, and the vascularity of the administration site

CNS, central nervous system; FNB, femoral nerve block; ISBPNB, interscalene brachial plexus nerve block; LB, liposomal bupivacaine; pMVL, proprietary multivesicular liposome technology; TKA, total knee arthroplasty.

Compare the cost

EXPAREL

$376.12

266 mg (20 mL)

$227.63

133 mg (10 mL)

Continuous catheter

Average of $433.82 per patient for device alone8

In the face of shortages, EXPAREL requires significantly fewer local anesthetic resources than continuous catheters

vial 266
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bottle

One EXPAREL 266 mg (20 ml) single-use vial may require only one vial of bupivacaine‡

-OR-

Less than one vial of
bupivacaine when one EXPAREL 133 mg (10 ml) single-use vial is used in an interscalene brachial plexus nerve

vs

vial 266
arrow
bottle-grp

Continuous catheters require up to
10 to 15 vials of bupivacaine

EXPAREL delivers long-lasting pain control in a patient-friendly modality

  • No external devices attached to patients at discharge
  • No extra burden for patient to remove the catheter
  • No need for patient involvement once home
  • No unplanned phone calls related to patient compliance

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. Holmström B, Rawal N, Axelsson K, Nydahl PA. Risk of catheter migration during combined spinal epidural block: percutaneous epiduroscopy study. Anesth Analg. 1995;80(4):747-753.
  2. Marhofer D, Marhofer P, Triffterer L, Leonhardt M, Weber M, Zeitlinger M. Dislocation rates of perineural catheters: a volunteer study. Br J Anaesth. 2013;111(5):800-806.
  3. Capdevila X, Pirat P, Bringuier S, et al; French Study Group on Continuous Peripheral Nerve Blocks. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology. 2005;103(5):1035-1045.
  4. Remerand F, Vuitton AS, Palud M, et al. Elastomeric pump reliability in postoperative regional anesthesia: a survey of 430 consecutive devices. Anesth Analg. 2008;107(6):2079-2084.
  5. Patel MA, Gadsden JC, Nedeljkovic SS, et al. Brachial plexus block with liposomal bupivacaine for shoulder surgery improves analgesia and reduces opioid consumption: results from a multicenter, randomized, double-blind, controlled trial. Pain Med. 2020;21(2):387-400.
  6. Gadsden J, et al. Poster presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting; April 20, 2023; Hollywood, FL. Poster 4381.
  7. Schwartz G, Gadsden JC, Gonzales J, et al. A phase 3 active-controlled trial of liposomal bupivacaine via sciatic nerve block in the popliteal fossa after bunionectomy. J Clin Anesth. 2024;94:111402.
  8. Corman S, Shah N, Dagenais S. Medication, equipment, and supply costs for common interventions providing extended post-surgical analgesia following total knee arthroplasty in US hospitals. J Med Econ. 2018;21(1):11-18.
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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