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What to know about administering EXPAREL® (bupivacaine liposome injectable suspension) 

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EXPAREL is a versatile, long-lasting non-opioid postsurgical pain management option

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that can be infiltrated directly into the surgical site to produce local analgesia in patients 6 years of age and older

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or as an interscalene brachial plexus nerve block in adult patients to produce postsurgical regional analgesia.

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Safety and efficacy have not been established in other nerve blocks.

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EXPAREL uses a proprietary multivesicular liposome (pMVL) delivery technology that encapsulates bupivacaine HCl in a suspension of multivesicular liposomes.

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As the naturally occurring, biocompatible lipids are metabolized,

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the bupivacaine is slowly released over time to consistently deliver safe levels of bupivacaine and provide extended analgesia.

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EXPAREL is administered differently than bupivacaine HCl, allowing for precise delivery of analgesia.

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EXPAREL stays precisely where placed and does not readily diffuse into surrounding tissue. 

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Administering EXPAREL requires more injections to ensure enough multivesicular liposomes

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are available at the pain receptors to continuously release bupivacaine.

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Clinicians should consider the size, vascularity and the neuroanatomy of the surgical site to ensure optimal analgesic coverage.

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EXPAREL can be expanded with normal saline or lactated Ringer’s solution.

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Maintain a minimum concentration of point eighty-nine milligrams per milliliter.

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To achieve early analgesic onset, bupivacaine HCl may be administered immediately before EXPAREL or admixed in the same syringe,

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as long as the ratio of the milligram dose of bupivacaine HCl to EXPAREL does not exceed one to two.

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Other than bupivacaine HCl, EXPAREL should not be admixed with other drugs prior to administration.

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Administering EXPAREL as a local infiltration into the surgical site or as a fascial plane block

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EXPAREL should be infiltrated deep into all layers of tissue using a moving needle technique with a series of injections around the entire surgical site.

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infiltrate above and below the fascia and into the subcutaneous tissue,

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in small areas one to one and a half centimeters apart using one to two milliliters per injection site to ensure adequate pain receptor coverage. 

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Use a twenty-five-gauge or larger-bore needle to maintain the structural integrity of the liposomes.

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Aspirate frequently to reduce the chance of an inadvertent intravascular injection. 

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The maximum dose of EXPAREL is two hundred sixty-six milligrams or twenty milliliters.

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EXPAREL provides regional analgesia when used in fascial plane or field block techniques

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such as transversus abdominis plane or TAP, 

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pectoralis or PEC, serratus, erector spinae plane or ESP, and quadratus lumborum or QL blocks.

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if using ultrasound guidance, visualize the desired fascial plane and inject EXPAREL to spread along the plane.

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If using a laparoscope during the procedure, identify the desired fascial plane under direct visualization

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and inject EXPAREL to allow for the spread along the plane. 

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Administering EXPAREL in Interscalene Brachial Plexus Nerve Blocks 

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EXPAREL is indicated only in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. 

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safety and efficacy have not been established in other nerve blocks.

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When administering EXPAREL as an interscalene brachial plexus nerve block,

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the maximum dose of EXPAREL should not exceed one hundred-thirty-three milligrams or a single, ten milliliter vial. 

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Use ultrasound to identify the anterior and middle scalene muscles and the elements of the brachial plexus that are located between them.

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A color Doppler can aid in identifying and avoiding vascular structures.

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Insert the needle in-plane toward the brachial plexus, typically in a lateral-to-medial direction,

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although a medial-to-lateral needle orientation can also be used if there is no room for the former.

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The needle should always be aimed in between the nerve roots instead of directly at them

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in order to minimize the risk of accidental nerve injury.

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Inject until EXPAREL is adequately spread around the brachial plexus, as confirmed in ultrasound.

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Additional needle repositioning and injections may be necessary.

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Aspirate frequently to reduce the chance of an inadvertent intravascular injection.

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For training or education events, procedure videos, case reports, and technique guides, visit www.EXPAREL.com