EXPAREL Provides Pain Relief When It Matters Most
EXPAREL in Knee Surgery
Clinical Efficacy
Manage Pain & Minimize Opioids After TKA
EXPAREL vs bupivacaine HCI in TKA1
78% Fewer Opioids*
overall opioid consumption (P=0.0048)
Significantly Better Pain Control
cumulative pain scores (P=0.0381)†
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials
†Pain measured using the visual analog scale
AUC, area under the curve; TKA, total knee arthroplasty; VAS, visual analog scale.
Multimodal Protocols & Results
Multimodal approaches with or without ERAS protocols have demonstrated benefits in knee surgery
Multimodal Protocol
Preoperative
- Celecoxib 200 mg orally
- Acetaminophen 1000 mg orally
- Pregabalin 50 mg orally
Intraoperative
Both groups:
- Fentanyl (or fentanyl analogs)
- Spinal anesthesia
EXPAREL group
- EXPAREL 266 mg/20 mL + 0.5% bupivacaine HCl 20 mL + saline 80 mL
Bupivacaine HCl group:
- 0.5% bupivacaine HCl 20 mL + saline 100 mL
Postsurgical
- Celecoxib 200 mg orally every 12 hours until discharge
- Acetaminophen 975 mg to 1000 mg orally every 8 hours (maximum of 3000 mg/day)
- Immediate-release oxycodone ≤10 mg orally every 4 hours (maximum) or as needed; if oral therapy was not tolerated, morphine 2.5 to 5 mg intravenously or hydromorphone 0.5 to 1 mg intravenously every 4 hours or as needed
Patients Who Received Multimodal Analgesia With EXPAREL
Less Pain
180.8 vs 209.3 cumulative AUC of VAS 12 to 48 hours after surgery (P=0.0381)
Fewer Opioids*†
18.7 mg vs 84.9 mg 0 to 48 hours (P=0.0048)
More Opioids-Free
10% vs 0% in the first 72 hours (P=0.01)
*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; TKA, total knee arthroplasty; VAS, visual analog scale.
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 opioids 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. ASP, average sales price; CMS, Centers for Medicare and Medicaid Services.
