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Dosing for local infiltration
Dosing for local infiltration
For adults, a maximum dose of 266 mg (20 mL) is recommended, 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
For pediatric patients aged 6 to less than 17 years, dosing is weight based: 4 mg/kg (up to a maximum of 266 mg)
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
Case studies in plastic surgery
See how your peers are using EXPAREL for optimal pain coverage
Societies recommend opioid-minimizing pain management platforms
Leading medical societies recommend opioid-minimizing pain management strategies to enhance recovery after plastic surgery
ASPS
Use of multimodal approaches should be considered over the use of single agents, particularly narcotics.1
ASPS, American Society of Plastic Surgeons.
EXPAREL has been used across plastic surgeries from abdominoplasty and mammaplasty to breast and abdominal wall reconstruction
In cosmetic procedures
4HR SHORTER mean length of stay in obesity class I mammaplasty patients vs bupivacaine HCI
(P=0.038)2*
39% REDUCED postoperative dose of hydromorphone in abdominoplasty as part of TAP block vs standard nerve block
(2.63 mg vs 4.31 mg; P=0.024)3†‡
In reconstructive procedures
24% REDUCED pain scores at discharge in mammaplasty vs presurgical paravertebral block
(3.2 vs 4.2; P <0.008)4§
47% REDUCED postsurgical opioid consumption in implant-based breast reconstruction vs bupivacaine HCI
(0.76 MED/h vs 1.43 MED/h; P=0.017)5‡¶
36% REDUCED length of stay in implant-based breast reconstruction vs bupivacaine HCI
(29.8 hours vs 46.7 hours; P=0.035)6¶
29% REDUCED mean total costs in abdominal wall & breast reconstruction procedures vs bupivacaine HCI
($28,021 vs $39,531; P=0.02)6#
*Retrospective review of reduction mammaplasty patients (N=113) treated with bupivacaine HCl (n=34) or EXPAREL (n=79).2
†Pilot study in which abdominoplasty patients (N=32) received either EXPAREL with TAP block (n=16) or a combination of pararectus injections and ilioinguinal/iliohypogastric nerve blocks (n=16).3
‡The clinical benefit of the decrease in opioid consumption was not demonstrated in pivotal trials.
§A retrospective review of patients (N=97) who underwent mastectomy with immediate tissue expander reconstruction using preoperative paravertebral block (n=53) compared with those treated with intraoperative EXPAREL infiltration (n=44).4
¶A prospective, randomized, single-blind trial comparing bupivacaine HCl (n=12) with EXPAREL (n=12) in patients undergoing implant-based breast reconstruction.5
#A retrospective claims analysis using the Vizient Clinical Data Base/Resource Manager abstract discharge database to identify abdominal wall and breast reconstruction procedures at participating hospitals.6
TAP, transversus abdominis plane.
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.
References
- American Society of Plastic Surgeons. ASPS statement on opioids. https://www.plasticsurgery.org/for-medical-professionals/health-policy/opioid-prescribing-resources Accessed February 21, 2023.
- Kalaria SS, Boukovalas S, Padilla PL, Tran JP, Li RT, Phillips LG. Liposomal bupivacaine may benefit select reduction mammaplasty patients. Ann Plast Surg. 2018;80(3):223-227.
- Fiala T. Tranversus abdominis plane block during abdominoplasty to improve postoperative patient comfort. Aesthet Surg J. 2015;35(1):72-80.
- Abdelsattar JM, Boughey JC, Fahy AS, et al. Comparative study of liposomal bupivacaine versus paravertebral block for pain control following mastectomy with immediate tissue expander reconstruction. Ann Surg Oncol. 2016;23(2):465-470.
- Motakef S, Wong WW, Ingargiola MJ, et al. Liposomal bupivacaine in implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2017;5(11):e1559.
- Little A, Brower K, Keller D, Ramshaw B, Janis JE. A cost-minimization analysis evaluating the use of liposomal bupivacaine in reconstructive plastic surgery procedures. Plast Reconstr Surg. 2019;143(4):1269-1274.
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EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration
