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This case study represents an individual clinician experience with and methodology for using EXPAREL.
Pacira BioSciences, Inc., recognizes that there are other methodologies for administering local anesthetics, as well as individual patient considerations, when selecting the dose for a specific procedure.
Please see Important Safety Information below and refer to the Full Prescribing Information.
Disclosure: Dr Rosen is a paid consultant for Pacira BioSciences, Inc.
The recommended dose of EXPAREL for infiltration in adults is based on the size of the surgical site, the volume required to cover the area, and individual patient factors that may impact the safety of an amide local anesthetic. The maximum dose of EXPAREL should not exceed 266 mg. The recommended dose of EXPAREL for patients aged 6 to <17 years old is 4 mg/kg, up to a maximum of 266 mg. The recommended dose of EXPAREL in adults for interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal is 133 mg. The recommended dose of EXPAREL in adults for adductor canal block is 133 mg (10 mL) admixed with 50 mg (10 mL) of 0.5% bupivacaine HCl, for a total volume of 20 mL.
EXPAREL can be administered unexpanded (20 mL) or expanded to increase volume up to a total of 300 mL (final concentration of 0.89 mg/mL [ie, 1:14 dilution by volume]) with normal (0.9%) saline or lactated Ringer’s solution.
Bupivacaine HCl (which is approved for use in patients aged 12 and older) may be administered immediately before EXPAREL or admixed in the same syringe, as long as the ratio of the milligram dose of bupivacaine HCl to EXPAREL does not exceed 1:2. Admixing may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. The toxic effects of these drugs are additive and their administration should be used with caution, including monitoring for neurological and cardiovascular effects related to local anesthetic systemic toxicity. Other than with bupivacaine, EXPAREL should not be admixed with other drugs prior to administration.
ASSESSED THE SIZE OF THE SURGICAL SITE AND DEPTH OF TISSUE, THEN PREPARED INJECTION MATERIALS ACCORDINGLY
In this procedure, Dr Rosen determined a total volume of 80 mL would be needed to cover the surgical site. He admixed 20 mL of EXPAREL® (bupivacaine liposome injectable suspension) with 20 mL of 0.25% bupivacaine HCl and 40 mL of normal saline in a stainless steel basin before drawing into 10-mL aliquots (8 syringes). He used a 25-gauge, 1.5-cm needle on a 10-mL luer lock syringe with thumb plunger and finger rings to facilitate 1-handed aspiration and injection.
In cases that require a higher total volume, Dr Rosen may add normal saline to increase the total volume to 100 mL.
MARKED THE SURGICAL SITE FOR INFILTRATION
Dr Rosen used a surgical marker to mark the midline and paramedian lines on the abdominal wall. This vertical grid pattern served as a guide for Dr Rosen as he distributed the admixture to ensure complete and uniform analgesic coverage.
DIVIDED INJECTATE INTO SYRINGES WITH NEEDLE GAUGES APPROPRIATE FOR INFILTRATION (20- TO 25-GAUGE) AND PLANNED WHICH AREAS TO INFILTRATE WITH EACH INJECTION
Dr Rosen performed all cases with his physician assistant operating simultaneously. In the abdominoplasty procedure, the lower incision was made by the primary surgeon, then both operators used cautery to dissect down to the fascia, raising the flaps on their respective sides. The primary surgeon performed the fascial plication in 2 layers, and then EXPAREL was infiltrated by both surgeons simultaneously.
EXPAREL was infiltrated under the entire abdominal wall fascia from pubis to xiphoid and laterally to the lateral border of the external oblique muscles.
To ensure complete analgesic coverage of the surgical site, Dr Rosen assumed that 1 mg of expanded EXPAREL would be infiltrated into the abdominal wall fascia for every 2 cm of surgical incision.
ASP, average sales price; CMS, Centers for Medicare and Medicaid Services.
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.
Please refer to full Prescribing Information.
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration
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