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Take Control of Postsurgical Pain With the Power of EXPAREL

Overview

Effective Pain Control Is Key to Positive Surgical Outcomes

For your patients, uncontrolled postsurgical pain can mean more than just discomfort. Without effective pain management, they may face poor clinical outcomes such as1-4:

Delayed recovery 
& ambulation1

Prolonged use 
of opioids2

Higher rates of healthcare utilization, including readmissions and ED visits1,3

Development of chronic pain4

Consistent and effective pain control immediately after surgery helps make recovery more predictable—for both you and your patients.5

ED, emergency department.

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EXPAREL provides lasting pain relief through the critical days following surgery, targeting pain when at its worst.

Mechanism of Action

EXPAREL Extends Analgesia with Advanced Technology

EXPAREL Uses Proprietary Multivesicular Liposome (pMVL) Technology, an Advanced Drug Delivery System That6:

Diagram of the mechanism of action of EXPAREL.
1

Releases

bupivacaine gradually over time

2

Achieves

effective, localized pain control directly at the surgical site

3

Maintains

therapeutic consistency while minimizing systemic exposure

ERAS & Multimodal Protocols

EXPAREL Improves Postsurgical Outcomes When Added to Enhanced Recovery After Surgery (ERAS) Protocols7-9

ERAS protocols are multimodal pathways for comprehensive perioperative care that help make early recovery after surgery possible by supporting preoperative organ function and reducing postsurgical stress10

ERAS protocols have been shown to reduce complications and morbidity rate as well as generate cost savings11,12

One of the key elements in ERAS protocols is use
of multimodal pain management strategies to minimize opioid-based postsurgical pain control13

Evidence Is Growing That the Addition of EXPAREL to ERAS Protocols Improves Postsurgical Outcomes for a Variety of Surgical Procedures:

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    Hernia repair14
  • Checkmark
    Lumpectomy16
  • Checkmark
    Abdominal wall reconstruction18
  • Checkmark
    Thoracotomy20
  • Checkmark
    C-section22
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    Breast reconstruction15
  • Checkmark
    Liver surgery17
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    Nephrectomy19
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    Spinal surgery21
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    TKA (total knee arthroplasty)23

Enhanced Recovery Protocols

With Multimodal Analgesia Reduce Opioid Consumption, ORAEs, and Improve Recovery Outcomes24

Reduce Pain25

Minimize ORAEs26

Reduce
Discharge Time27

Decrease Costs28

ORAE, opioid-related adverse event.

Use a Multimodal Approach to Reduce Postsurgical Pain & Opioid Use

Multimodal analgesia is the utilization of multiple pain management modalities for more effective pain control, which can lead to enhanced clinical and economic benefits

Decreases In

  • Opioid use29
  • Postsurgical complications31
  • Risk of developing chronic pain33
  • Acute postsurgical pain30
  • Length of hospital stay29,32
  • Cost per patient29,32

Improvements In

  • Efficiency of hospital resources29,32
  • Patient satisfaction30,31,34

Limitations of Alternatives

Some Postsurgical Pain Management Alternatives Can Pose Risks

Challenges With Continuous Nerve Blocks

Continuous nerve blocks through pumps or catheters can extend hospital stays due to costs, difficulty in placement, inefficiencies in workflow management, migration, dislodgement, and leakage, leading to suboptimal pain control.35-39

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Why Risk Toxicity With Pumps & Catheters?

pMVL provides a sustained release of bupivacaine HCI over time, maintaining plasma levels below toxic thresholds in various nerve blocks40-42

Systemic Plasma Bupivacaine HCI Concentration, ng/mL

Line graph comparing systemic plasma bupivacaine HCl concentrations over 72 hours for three methods of administration; the continuous catheter method shows the highest peak concentration.

Swipe left on chart to see more

Mean Cmax

209.35 ng/mL

EXPAREL 133 mg ISBPNB40

381.62 ng/mL

EXPAREL 133 mg Sciatic nerve block in the popliteal fossa42

  • Systemic plasma levels of bupivacaine HCI 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

Cmax, maximum concentration; 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

$398.69

266 mg (20 mL)

$241.29

133 mg (10 mL)

Continuous Catheter

$433.82 

on average per patient for device alone43

In the Face of Shortages, EXPAREL Requires Significantly Fewer Local Anesthetic Resources Than Continuous Catheters

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

Or

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

Versus

It may take 10-15 vials of bupivacaine HCl to fill a typical 400 mL pain pump

EXPAREL Delivers Long-Lasting Pain Control in a Patient-Friendly Modality35,44,45

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

Risks of Compounded Cocktails

Since third-party compounded cocktails are not FDA-approved or reviewed for safety, they may pose serious risks and fail to match the efficacy of FDA-approved alternatives.46

Concerns With Opioid Reliance

Up to 95% of surgical patients receive opioids, yet poor pain management can lead to dependency, misuse, or persistent opioid use.47,48

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References
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  2. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504. Published correction appears in JAMA Surg. 2019;154(3):272. doi: 10.1001/jamasurg.2018.5476
  3. Vadivelu N, Kai AM, Kodumudi V, Berger JM. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting. J Pain Res. 2016;9:425-435. doi:10.2147/JPR.S86579
  4. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93(4):1123-1133. doi:10.1097/00000542-200010000-00038
  5. Berkowitz R, Vu J, Brummett C, Waljee J, Englesbe M, Howard R. The impact of complications and pain on patient satisfaction. Ann Surg. 2021;273(6):1127-1134. doi:10.1097/SLA.0000000000003621
  6. Dagenais S, Scranton R, Joyce AR, Vick CC. A comparison of approaches to identify possible cases of local anesthetic systemic toxicity in the FDA Adverse Event Reporting System (FAERS) database. Expert Opin Drug Saf. 2018;17(6):545-552. doi:10.1080/14740338.2018.1474200
  7. Eubanks AL, Grabski DF, Pollack J, et al. A multimodal protocol utilizing liposomal bupivacaine rib blocks leads to opioid reduction in patients undergoing the Nuss procedure. J Thorac Dis. 2021;13(11):6363-6372. doi:10.21037/jtd-21-1314
  8. Villadiego L, Baker BW. Improving pain management after cesarean birth using transversus abdominis plane block with liposomal bupivacaine as part of a multimodal regimen. Nurs Womens Health. 2021;25(5):357-365. doi:10.1016/j.nwh.2021.07.009
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  16. Rojas KE, Manasseh D-M, Flom PL, et al. A pilot study of a breast surgery Enhanced Recovery After Surgery (ERAS) protocol to eliminate narcotic prescription at discharge. Breast Cancer Res Treat. 2018;171(3):621-626.
  17. Day RW, Cleeland CS, Wng XS, et al. Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg. 2015;221(6):1023-1030.
  18. Fayezizadeh M, Petro CC, Rosen MJ, Novitsky YW. Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg. 2014;134(4 suppl 2):151S-159S.
  19. Rege A, Leraas H, Vikraman D, et al. Could the use of an enhanced recovery protocol in laparoscopic donor nephrectomy be an incentive for live kidney donation? Cureus. 2016;8(11):e889.
  20. Van Haren RM, Mehran RJ, Mena GE, et al. Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer. Ann Thorac Surg. 2018;106(1):272-279.
  21. Wang MY, Chang P-Y, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411-418.
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  23. Van Horne A, Van Horne J. Patient-optimizing enhanced recovery pathways for total knee and hip arthroplasty in Medicare patients: implication for transition to ambulatory surgery centers. Arthroplast Today. 2019;5(4):497-509.
  24. Elkassabany NM, Wang A, Ochroch J, Mattera M, Liu J, Kuntz A. Improved quality of recovery from ambulatory shoulder surgery after implementation of a multimodal perioperative pain management protocol. Pain Med. 2019;20(5):1012-1019.
  25. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician. 2001;63(10):1979-1984.
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  36. Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:560879. doi:10.1155/2012/560879
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  43. 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.
  44. Jeng CL, et al. Complications of peripheral nerve block. Br J Anaesth. 2010;105: 97-107
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