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Effective January 1, 2025: ASP+6% reimbursement for EXPAREL when billing with code J0666 across all outpatient surgical settings.

Be an advocate for non-opioid postsurgical pain control

You've always done all you can for your patients. They trust you to listen to them and take their pain seriously. Now show them the difference
a multimodal postsurgical pain management approach with EXPAREL can make for their recovery goals.

  • Enhanced recovery after surgery (ERAS) guidelines recommend a multimodal approach to postsurgical pain management, including less reliance on opioids1
  • Multimodal analgesia is the use of multiple pain management modalities for more effective pain control, which can lead to enhanced clinical and economic benefits2
  • As the foundation of a multimodal approach, non-opioid EXPAREL can help reduce—or even eliminate—the use of postsurgical opioids, while providing the pain control patients need3*

To minimize postsurgical pain with EXPAREL

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Get a nurse's perspective

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Why do patients trust nurses so strongly?

Nurses are the most trusted professionals.

For the past 20 years, nursing has been the top-ranked profession for high honesty and ethics.4†

95% of patients say listening to them is critical5‡

*The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.

†Annual Gallup rating of the honesty and ethics of various professions.

‡Beryl Institute survey of what health care consumers consider to be extremely important to their experience.

Your role in implementing the ERAS plan is critical

Inadequate pain management after surgery can lead to unintended consequences for your patients—from chronic pain to extended hospital stays. In addition, postsurgical pain significantly contributes to patient dissatisfaction with the anesthesia and surgical experience.6

ERAS protocols help improve key postsurgical outcomes by significantly reducing7§

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Pain scores within the first 24 hours of surgery

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Opioid consumption for first 48hrs after surgery

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Hospital LOS from admission to discharge

As a nurse, your role in the multidisciplinary ERAS team includes

  • Providing essential patient education for each step of the surgical care experience: preoperative, intraoperative, and postoperative8
  • Assessing the patient's pain level and tolerance9
  • Facilitating communication between the physician and the patient9
  • Informing caregivers about the patient's status8,9
doctors team

TEAMWORK is key to ERAS pathway success

  • Nurses
  • Surgeons
  • Anesthesiologists
  • Administrators
Contact a Clinical Educator for ERAS support

§Data shown are from colorectal surgery.

LOS, length of stay.

Avoid the complications of opioids

Opioid-related adverse events (ORAEs) can add to your workload. With the growing number of patients you’re caring for, you shouldn’t have to contend with patients who are:

  • Sick from ORAEs like nausea and vomiting6,10
  • Having difficulty breathing due to respiratory depression6
  • Complaining of discomfort with opioids, such as pruritus6
  • Slow to ambulate due to light-headedness and oversedation11
  • Experiencing discharge delays due to ORAEs12

Fortunately, there are non-opioid postsurgical pain management options to help you. If additional pain relief is needed after surgery, patients should receive an around-the-clock regimen of NSAIDs, COX inhibitors, and/or acetaminophen (unless contraindicated).13,14

You can help minimize opioid use by advocating for a multimodal pain management approach that includes EXPAREL with both the physician and the patient:

  • Inform patients about multimodal approaches and non-opioid pain management options
  • Empower patients to speak up and ask the physician for non-opioid options
  • Share the ORAEs you see with the prescribing physician

Help your patients manage postsurgical pain with minimal opioid use.

Download iconDownload Handout

COX, cyclooxygenase; NSAID, non-steroidal anti-inflammatory drug.

Nurses are stewards for opioid administration

If you are administering pain management medications following surgery, consider the patient types who may react differently to opioids.

For example:

Opioid-naive patients may not realize the impact of opioids extends beyond pain control10

  • Educate them on the side effects of and risks of opioids: abuse, addiction, and diversion15
  • Provide safe disposal instructions15

Patients with a history of opioid or substance use disorder14

  • Confirm if patients need non-opioid pain medication to avoid the risk of relapse that may compromise their sobriety
See the overall impacts of opiods

National Nursing Societies Agree on Limiting Opioid Use

AORN, Association of periOperative Registered Nurses; ASPAN, American Society of PeriAnesthesia Nurses; ASPMN, American Society for Pain Management Nursing; AWHONN, Association of Women’s Health, Obstetric, and Neonatal Nurses; NAON, National Association of Orthopaedic Nurses; SUD, substance use disorder.

The first few days after surgery can be the most painful for patients

One of the most critical opportunities with ERAS protocols is postsurgical pain management2,21

  • Optimizing pain management after surgery can positively impact factors such as ambulation, reducing LOS, and reducing opioids
  • Pain relief remains an unmet need:

75% to 88% of patients report moderate to extreme postsurgical pain6

Nearly 80% of patients preferred a non-opioid postsurgical pain management option22

EXPAREL can provide long-lasting, non-opioid pain relief for your patients:

  • When used as part of a multimodal protocol, EXPAREL aligns with ERAS guidelines by reducing the need for opioids as demonstrated in clinical trials§
  • The benefits of EXPAREL start during the surgical procedure and continue for days after your patients arrive home
  • ERAS and multimodal protocols with EXPAREL can help lessen your burden24
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Decreases the time needed to attend to each patient after surgery

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Reduces follow-up calls
after discharge

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Improves patient
satisfaction scores

24 hours after surgery for knee OA25

85% of patients were satisfied with EXPAREL
pain control

vs

69% of patients who did not receive EXPAREL

A phase 4, multicenter, double-blind, active-controlled, parallel-group trial in which patients were randomized 1:1 to receive local infiltration analgesia with EXPAREL (n=70) or bupivacaine HCl alone (n=69; P=0.036).

Optimize patient experience with EXPAREL

During surgery2

EXPAREL is administered during surgery and works directly at the site to provide targeted analgesia.

After surgery24,26

Unlike PCA, EXPAREL controls pain while minimizing the need for opioids without pumps or catheters. Less opioid use reduces the risk of opioid-related side effects that can hinder the achievement of key recovery milestones (eg, time to first bowel movement or flatus, eating solid foods, ambulation, and discharge).

At home27

With up to 72 hours of pain control, EXPAREL helps patients recover without the side effects of opioids.

1
2
3

§The clinical benefit of the decrease in opioid consumption was not demonstrated in the pivotal trials.

ERAS, enhanced recovery after surgery; LOS, length of stay; PCA, patient-controlled analgesia.

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Important Notice

Indication

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.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia.
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation.
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia.
  • Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine.
  • EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, and/or pregnant patients.
  • Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease.

Warnings and Precautions Specific to EXPAREL

  • Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL.
  • EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks other than interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block, or intravascular or intra-articular use.
  • The potential sensory and/or motor loss with EXPAREL is temporary and varies in degree and duration depending on the site of injection and dosage administered and may last for up to 5 days, as seen in clinical trials.

Warnings and Precautions for Bupivacaine-Containing Products

  • Central Nervous System (CNS) Reactions: There have been reports of adverse neurologic reactions with the use of local anesthetics. These include persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression.
  • Cardiovascular System Reactions: Toxic blood concentrations depress cardiac conductivity and excitability, which may lead to dysrhythmias, sometimes leading to death.
  • Allergic Reactions: Allergic-type reactions (eg, anaphylaxis and angioedema) are rare and may occur as a result of hypersensitivity to the local anesthetic or to other formulation ingredients.
  • Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use.
  • Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.

Please refer to full Prescribing Information.

References

  1. Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J Anesthesiol. 2018;71(5):345-352.
  2. Stenberg E, Dos Reis Falcão LF, O’Kane M, et al. Guidelines for preoperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: a 2021 update. World J Surg. 2022;46(4):729-751.
  3. Portillo J, Kamar N, Melibary S, Quevedo E, Bergese S. Safety of liposome extended-release bupivacaine for postoperative pain control. Front Pharmacol. 2014;5:90.
  4. Gallup Nurse Poll. National Nurses United. January 13, 2022.
  5. Wolf AJ. Nurse Leadership and the Human Experience: a framework for evaluating care and caring. Nurse Lead. 2019;17(4):347-351.
  6. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-2298.
  7. Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen L-L. Successful implementation of an enhanced recovery after surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol. 2016;16(1):55.
  8. Pena CG. What makes a nurse a good ERAS nurse? Asia Pac J Oncol Nurs. 2022;9(7):100034.
  9. American Association of Nurse Anesthesiology. Enhanced recovery after surgery: considerations for pathway development and implementation. https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/professional-practice-manual/enhanced-recovery-after-surgery.pdf?sfvrsn=6d184ab1_14 Published July 2017. Accessed January 13, 2023.
  10. Shafi S, Collinsworth AW, Copeland LA, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg. 2018;153(8):757-763.
  11. Rivas E, Cohen B, Pu X, et al. Pain and opioid consumption and mobilization after surgery: post hoc analysis of two randomized trials. Anesthesiology. 2022;13(6):115-126.
  12. Pizzi LT, Toner R, Foley K, et al. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacother. 2012;32(6):502-514.
  13. Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26(3):191-196.
  14. Cheung CK, Adeola JO, Beutler SS, Urman RD. Postoperative pain management in enhanced recovery pathways. J Pain Res. 2022;15:123-135.
  15. Oliver J, Coggins C, Compton P, et al. American Society for Pain Management Nursing position statement: pain management in patients with substance use disorders. Pain Manag Nurs. 2012;13(3):169-183.
  16. Association of Registered Nurses. 6 things to know about multimodal postoperative pain management. https://www.aorn.org/article/2020-12-04-Things-to-Know Accessed March 20, 2023.
  17. American Society of PeriAnesthesia Nurses. A position statement on opioid stewardship in perianesthesia practice. https://www.aspan.org/Portals/88/Clinical Practice/Position Statements/Current/PS_15.pdf?ver=2021-01-12-153636-503 Accessed January 4, 2023.
  18. Quinlan-Colwell A, Rae D, Drew D. Prescribing and administering opioid doses based solely on pain intensity: update of a position statement by the American Society for Pain Management Nursing. Pain Manag Nurs. 2022;23:68-75.
  19. Association of Women’s Health, Obstetric and Neonatal Nurses. Optimizing outcomes for women with substance use disorders in pregnancy and the postpartum period. J Obstet Gynecol Neonatal Nurs. 2019;48(5):583-685.
  20. National Association of Orthopaedic Nurses. Position statement: opioid epidemic. 2018. Statements/Final_NAON_Opioid_Position_Statement_01.2019.pdf
  21. Kalogera E, Bakkum-Gamex JN, Jankowski CJ, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122(201):319-318.
  22. Data on File. 6450. Parsippany, NJ: Pacira BioSciences, Inc.; January 2021.
  23. Tirotta CF, de Armendi AJ, Horn ND, et al. A multicenter study to evaluate the pharmacokinetics and safety of liposomal bupivacaine for postsurgical analgesia in pediatric patients aged 6 to less than 17 years (PLAY). J Clin Anesth. 2021;75:110503.
  24. Miller TE, Thacker JK, White WD, et al. Enhanced Recovery Study Group. Reduced length of hospital in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052-1061.
  25. Dysart SH, Barrington JW, Del Gaizo DJ, Sodhi N, Mont MA. Local infiltration analgesia with liposomal bupivacaine improves early outcomes after total knee arthroplasty: 24-hour data from the PILLAR study. J Arthroplasty. 2019;34(5):882-886.e1.
  26. Altman AD, Helpman L, McGee J, et al; on behalf of the Society of Gynecologic Oncology of Canada’s Communities of Practice in ERAS and Venous Thromboembolism. Enhanced recovery after surgery: implementing a new standard of surgical care. CMAJ. 2019;191(17):E469-E475.
  27. Bergese SD, Ramamoorthy S, Patou G, et al. Efficacy profile of liposome bupivacaine for postsurgical analgesia. J Pain Res. 2012;5:107-116.
SEE MORE

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.

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