EXPAREL Provides Pain Relief When It Matters Most
EXPAREL in Breast Surgery
Clinical & Economic Outcomes
EXPAREL is a cost-effective option for postsurgical pain management both in the hospital and in outpatient settings
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials
†Opioid consumption was noted and converted to MED per hour of hospital stay1
‡All pain was measured with the visual analog scale2,4
§Opioid consumption was measured using IV morphine equivalent (mg)3
¶Parenteral and oral opioid intake was converted into oral morphine equivalents (mg) using standardized calculations4
Multimodal Protocols & Results
Multimodal approaches with or without ERAS protocols have demonstrated benefits in breast surgeries.
Protocol implementation can positively impact recovery4
- 35% shorter LOS3
- 71% decrease in opioid use4
- No reported increase in pain or complications3
Multimodal Protocol
Intraoperative
- Bilateral TAP block with EXPAREL 266 mg/20 mL expanded with saline 180 mL
- Acetaminophen intravenously
- Ketorolac intravenously
- General anesthesia
Postsurgical
PACU
- Ketorolac 15 mg intravenously every 6 hours for 3 days
- No intravenous PCA
- Provision of oral or intravenous opioids for breakthrough pain
POD 1
- Ketorolac 15 mg orally as needed after intravenous regimen
Patients Who Received Multimodal Analgesia With EXPAREL
Fewer Opioids Used*†
46.0 mg vs 70.5 mg (P=0.003)
Shorter LOS
4.0 days vs 5.0 days (P<0.001)
*Opioid intake measured in MED (mg)
†The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
ERP, enhanced recovery pathway; LOS, length of stay; MED, morphine equivalent dosing; PACU, postanesthesia care unit; PCA, patient-controlled analgesia; POD, postoperative day; TAP, transversus abdominis plane.
Multimodal Protocol
Intraoperative
- Bilateral TAP block with EXPAREL 266 mg/20 mL expanded with saline 180 mL
- Acetaminophen intravenously
- Ketorolac intravenously
- General anesthesia
Postsurgical
PACU
- Ketorolac 15 mg intravenously every 6 hours for 3 days
- No intravenous PCA
- Provision of oral or intravenous opioids for breakthrough pain
POD 1
- Ketorolac 15 mg orally as needed after intravenous regimen
Patients Who Received Multimodal Analgesia With EXPAREL
Fewer opioids used*†
167.3 mg vs 574.3 mg (P<0.001)
Shorter LOS
3.9 days vs 5.5 days (P<0.001)
*Opioid intake measured in MED (mg)
†The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
ERAS, enhanced recovery after surgery; LOS, length of stay; MED, morphine equivalent dosing; TAP, transversus abdominis plane.
Societies Recommend Opioid-Minimizing Pain Management Platforms
The Breast Reconstruction Advisory Group and ERAS Society support the use of opioid-minimizing pain management strategies
Breast Reconstruction
Advisory Group2015 Guidelines
The authors propose an opioid-sparing multimodal analgesic clinical pathway for 4 common breast procedures...6
ERAS Society
Breast Reconstruction 2017
Strong recommendation for the use of multimodal opioid-sparing postsurgical pain bupivacaine regimens, noting that ‘a single injection of liposomal bupivacaine lasts for several days, potentially avoiding the need for catheter-based infusions.’7
ERAS, enhanced recovery after surgery.
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