Administration:

Exparel is injected directly into the surgical site by a healthcare professional. The medication is injected once during the surgery, and its long-acting effects help manage pain during the postoperative recovery period.

Precautions:

• Exparel should only be administered by a trained healthcare professional familiar with the medication and its proper administration techniques.
  
  
• Injection Site Monitoring: After the injection, the area where Exparel is administered should be carefully monitored for any signs of infection, swelling, or irritation.
  
  
• Avoid Overuse: The total amount of Exparel injected should not exceed the recommended dose for the specific procedure to avoid the risk of local anesthetic systemic toxicity (LAST).
  
  

Pain Management Plan: Exparel should be part of a comprehensive pain management plan that may also include other medications, such as oral analgesics. However, Exparel helps reduce the need for opioids after surgery.

Exparel contains bupivacaine, a potent local anesthetic, encapsulated in lipid microspheres. These microspheres are designed to slowly release bupivacaine over time, providing long-lasting pain relief.

After Exparel is injected into the surgical site, the liposomal formulation allows the bupivacaine to be gradually released, which helps maintain a constant level of local anesthesia for up to 72 hours. The slow release minimizes the peaks and troughs in pain relief that can occur with traditional, short-acting local anesthetics.

The local anesthetic works by blocking sodium channels in the nerve cells of the targeted area, preventing the transmission of pain signals to the brain. By providing prolonged local anesthesia, Exparel can significantly reduce the need for oral analgesics, such as opioids, during the recovery period.

Common Side Effects:

• Injection Site Reactions: The most common side effects of Exparel are related to the injection site, and may include:
  
  
  • Pain
    
    
  • Redness
    
    
  • Swelling
    
    
• Nausea: Some patients may experience mild nausea after the injection.
  
  
• Fever: A slight increase in body temperature can occur in some individuals.
  
  

Serious Side Effects:

• Local Anesthetic Systemic Toxicity (LAST): In rare cases, Exparel can cause systemic toxicity if too much of the medication is absorbed into the bloodstream. Symptoms of LAST include:
  
  
  • Seizures
    
    
  • Dizziness or lightheadedness
    
    
  • Confusion
    
    
  • Breathing difficulties
    
    
• Allergic Reactions: Severe allergic reactions are rare but can occur. Symptoms may include:
  
  
  • Hives
    
    
  • Difficulty breathing
    
    
  • Swelling of the face or throat
    
    

If any of these symptoms occur, immediate medical attention should be sought.

• Local Anesthetic Toxicity: While Exparel is generally safe when used as directed, it is important to avoid exceeding the recommended dose. Local anesthetic systemic toxicity (LAST) can occur if the medication is injected improperly or absorbed too rapidly into the bloodstream.
  
  
• Pregnancy and Breastfeeding: The safety of Exparel during pregnancy and breastfeeding has not been fully established. It should be used only if clearly needed and under the guidance of a healthcare provider.
  
  
• Preexisting Heart Conditions: Exparel should be used with caution in individuals with preexisting heart conditions, such as heart failure or arrhythmias, as local anesthetics can affect the heart’s electrical activity.
  
  

Allergic Reactions: Exparel should not be used in patients who have a known allergy to bupivacaine or any other ingredients in the formulation. If you have a history of severe allergic reactions to local anesthetics, discuss alternative pain management options with your doctor.

• CYP450 Enzyme Inhibitors/Inducers: While bupivacaine does not significantly interact with many drugs, it is still important to inform your healthcare provider of any medications you are currently taking, especially those that affect liver enzymes (CYP450 enzymes), as these could potentially alter the metabolism of Exparel.
  
  
• Other Local Anesthetics: Combining Exparel with other local anesthetics should be done with caution, as it may increase the risk of toxicity or overdose. Your doctor will assess whether this combination is appropriate for your specific case.
  
  

Anticoagulants: If you are taking blood thinners, there may be an increased risk of bleeding at the injection site. Inform your doctor about any anticoagulants or antiplatelet drugs you are using.

The dosage of Exparel is determined by the type of surgery and the patient’s individual needs:

• For Total Knee Arthroplasty (TKA): The typical dose is 266 mg (20 mL).
  
  
• For Liposuction: A dose of 266 mg (20 mL) is usually sufficient for large-area procedures.
  
  
• For Hernia Repair: The recommended dose is 133 mg (10 mL).
  
  

The dose should be administered once during surgery by a healthcare provider. It is important not to exceed the recommended dose to avoid potential side effects.

Exparel is a prescription-only medication and must be administered by a trained healthcare professional. It is not available for home use or over-the-counter purchase.

Before using Exparel, patients should undergo a complete medical evaluation, including discussions about any potential allergies, preexisting conditions, and pain management needs.

• What is Exparel used for?
  It is a long-acting local anesthetic used to manage post-surgical pain and reduce the need for opioids.

• What is the active ingredient?
  Bupivacaine liposome injectable suspension.

• How does Exparel work?
  It blocks nerve signal transmission, numbing the surgical area and providing extended pain relief.

• What makes Exparel different from regular bupivacaine?
  It uses a liposome delivery system that slowly releases bupivacaine, providing pain control for up to 72 hours.

• How is Exparel given?
  It is administered by a healthcare professional via injection at the surgical site or as a nerve block.

• What types of surgery is Exparel used for?
  Commonly used in orthopedic, abdominal, breast, and soft tissue surgeries.

• Does Exparel reduce opioid use after surgery?
  Yes, it is often used in multimodal pain management to reduce or eliminate the need for opioids.

• How long does Exparel last?
  Provides pain relief for up to 72 hours (3 days) after administration.

• Can Exparel be used in children?
  Approved for use in patients 6 years and older for wound infiltration; safety varies by indication.

• What are the common side effects?
  Nausea, vomiting, constipation, headache, and injection site pain.

• Are there serious side effects?
  Rare but possible—cardiac and central nervous system toxicity, seizures, or severe allergic reactions.

• Who should not receive Exparel?
  Patients with severe liver disease, certain heart rhythm disorders, or allergy to bupivacaine/amide anesthetics.

• Is Exparel used with other local anesthetics?
  Sometimes, but mixing with certain agents can affect its release—must be carefully managed by the provider.

• Can Exparel be repeated or given daily?
  No, it is intended as a single-dose injection per surgical procedure.

• Is Exparel safe during pregnancy?
  Use only if clearly needed—safety in pregnancy is not well established.

• Can it be used while breastfeeding?
  Bupivacaine can pass into breast milk in small amounts; discuss risks with your doctor.

• Does Exparel cause numbness for days?
  It may cause prolonged numbness at the injection site, which gradually wears off within 72 hours.

• How is Exparel different from nerve catheters or pumps?
  It provides extended pain relief in one injection, avoiding external devices or continuous infusions.

• Where is Exparel administered?
  In hospitals, surgical centers, and outpatient clinics—only by trained healthcare professionals.