EXPAREL Provides Pain Relief When It Matters Most
EXPAREL in Hip Surgery
Multimodal Protocols & Results
Multimodal approaches with or without ERAS protocols have demonstrated benefits in hip surgery
Multimodal Protocol
Preoperative
- Celecoxib 200 mg orally
- Acetaminophen 1000 mg orally
- Pregabalin 50 mg orally
Intraoperative
Both groups:
- Spinal (preferred) or general (alternate) anesthesia
- Injection of bupivacaine HCl
+ epinephrine 0.25% 40 mL,* morphine sulfate (1 mg/mL) 5 mL, and ketorolac (30 mg/mL) 1 mL
THA + EXPAREL group:
- Periarticular injection of EXPAREL 266 mg/20 mL in 0.9% saline 40 ml
THA + EXPAREL group:
- No EXPAREL administered
Postsurgical
- Patient-controlled analgesia for up to 24 hours after surgery
- Oral opioid as needed
- Morphine/hydromorphone HCI intravenously as needed for breakthrough pain
Patients Who Received Multimodal Analgesia With EXPAREL
Significant Pain Reduction
8 hours after surgery (P=0.031)
Fewer Opioids Used†‡
POD 1 (P=0.001)
POD 2 (P=0.016)
Achieved More Physical Therapy Milestones
Gait: 82% vs 64% (P<0.001)
Stairs: 93% vs 76% (P<0.001)
*The use of EXPAREL in combination with epinephrine is not part of the approved label
†Opioid intake measured in MED (mg)
‡The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
MED, morphine equivalent dosing; POD, postoperative day; THA, total hip arthroplasty.
Multimodal Protocol
- Patients were required to have a friend or family member who could assist with nonsurgical care and provide support on the day of surgery and for 3 days after surgery, in order to maintain adherence with medication, exercise, and analgesia protocols
- Patients and their assistants were educated on realistic pain expectations, dangers related to opioid use, opioid tapering, sleep hygiene, exercise and walking programs, walker safety, wound care, and home preparation
- Individualized preoperative opioid analgesia protocol
- Non-opioid analgesia protocol consisting of acetaminophen, meloxicam, or celecoxib utilized 1 week before surgery and for 6 weeks after surgery
- Spinal anesthesia
- Periarticular infiltration with EXPAREL 266 mg/20 mL, bupivacaine HCl, and adjuncts
- THA-specific protocol
- Anterior lateral femoral cutaneous nerve field block with EXPAREL 266 mg/20 mL and bupivacaine HCl
- TKA-specific protocol
- Adductor canal block with bupivacaine HCl
- Restricted intravenous opioid during surgery
Patients Who Received Multimodal Analgesia With EXPAREL
Same-Day Discharge
84% of patients were discharged on the day of surgery
High Pain Management Satisfaction
98.3% of patients were “very much” or a “good amount” satisfied with their pain management
Postsurgical Opioid Use*
84.2% of patients did not require an opioid prescription beyond the initial 7-day prescription provided at discharge
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
ERAS, enhanced recovery after surgery; THA, total hip arthroplasty; TKA, total knee arthroplasty.
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