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

Dosing for local infiltration

Dosing for local infiltration

For adults, a maximum dose of 266 mg (20 mL) is recommended, based on:

  • Size of the surgical site
  • Volume required to cover the area
  • Individual patient factors that may impact the safety of an amide local anesthetic

For pediatric patients aged 6 to less than 17 years, dosing is weight based: 4 mg/kg (up to a maximum of 266 mg)

Admixing bupivacaine HCl with 266 mg (20 mL) of EXPAREL

  • 20 mL vial contains 266 mg of EXPAREL, which is equivalent to 300 mg of bupivacaine HCl
  • 1:2 ratio allows 150 mg of bupivacaine HCl to 266 mg of EXPAREL
Expansion Techniques
Administration Guidance
dosing 266

Patients fear dental pain—but opioids aren’t the answer

1 out of 3 Americans avoids the dentist due to dental fear1*

What patients fear most is pain

70% of patients are prescribed opioids for postsurgical pain after a third molar extraction2

They also fear opioids because of the related risks

33% increased risk of future opioid use in patients prescribed opioids legitimately in 12th grade3

With EXPAREL, you can make patients comfortable with less reliance on opioids

Non-opioid EXPAREL is a proven, long-lasting anesthetic that controls pain for the first few days after surgery—when your patients need relief most. In third molar extraction, dental implants, and orthognathic and craniofacial procedures, opioid-sparing EXPAREL consistently demonstrates4-7:

LESS NEED FOR OPIOIDS

Third Molar Extraction4‡

59% REDUCTION in total prescribed opioids in MMEs4; 47.1 vs 113.8 MMEs; rate ratio, 0.41 (0.39–0.44) (P<0.0001)

57% REDUCTION in opioid prescription refill rate; 3.3% vs 7.7%, (P=0.028)

LESS PAIN

Craniofacial Procedures5§

97% REDUCTION in pain scores in the first 4 hours of the postsurgical period 0.1 ± 0.5 (SD) vs 3.7 ± 3.5 (SD) (P<0.001)

SIGNIFICANT REDUCTION in pain scores in the first 24 hours of the postsurgical period; 12 (P=0.010), 16 (P=0.002), 20 (P=0.006), and 24 (P=0.009) hours

*According to a 2018 global survey by DentaVox

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

‡Results from a retrospective cross-sectional analysis of patients undergoing third molar extraction (N=600) receiving local infiltration with EXPAREL (n=300) compared with patients who did not receive EXPAREL (n=300).4

§Results from a retrospective cohort study of patients undergoing alveolar bone grafting with an open iliac crest bone harvest (N=38) receiving EXPAREL at the hip donor site (n=17) compared with patients receiving bupivacaine HCl at the hip donor site (n=21).5

Societies recommend opioid-minimizing pain management platforms

Leading medical societies recommend opioid-minimizing pain management strategies to enhance recovery after oral and maxillofacial procedures

double-quotes

The oral and maxillofacial surgeon should avoid starting treatment with long-acting or extended-release opioid analgesics.8

AAOMS, American Association of Oral and Maxillofacial Surgeons (AAOMS).

Differentiate your practice with EXPAREL

Spread awareness about your non-opioid approach for managing postsurgical pain with patients and the community

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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. DentaVox: over 60% of people worldwide suffer from dental fear, 4% have never visited a dentist. https://www.biospace.com/article/-dentavox-over-60-percent-of-people-worldwide-suffer-from-dental-fear-4-percent-have-never-visited-a-dentist/ Published September 13, 2018. Accessed July 26, 2022.
  2. New research shows vast majority of oral surgery patients would choose non-opioid medication to treat postsurgical pain if given the option. https://www.globenewswire.com/news-release/2017/05/03/978035/0/en/New-Research-Shows-Vast-Majority-of-Oral-Surgery-Patients-Would-Choose-Non-opioid-Medication-to-Treat-Postsurgical-Pain-if-Given-the-Option.html?culture=fr-ca Published May 3, 2017. Accessed August 26, 2022.
  3. Miech R, Johnston L, O'Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015;136(5):e1169-e1177.
  4. Lieblich SE, Misiek D, Olczak J, Fleck H, Waterman F. A retrospective cross-sectional study of the effect of liposomal bupivacaine on postoperative opioid prescribing after third molar extraction. J Oral Maxillofac Surg. 2021;79(7):1401-1408.e1.
  5. Patel RA, Jablonka EM, Rustad KC, et al. Retrospective cohort-based comparison of intraoperative liposomal bupivacaine versus bupivacaine for donor site iliac crest analgesia during alveolar bone grafting. J Plast Reconstr Aesthet Surg. 2019;72(12):2056-2063.
  6. Iero PT, Mulherin DR, Jensen O, Berry T, Danesi H, Razook SJ. A prospective, randomized, open-label study comparing an opioid-sparing postsurgical pain management protocol with and without liposomal bupivacaine for full-arch implant surgery. Int J Oral Maxillofac Implants. 2018;33(5):1155-1164.
  7. Gulko JA, Carr BR, Neal TW, et al. Does liposomal bupivacaine injection decrease postoperative opioid usage following bimaxillary surgery? J Oral Maxillofac Surg. 2021;79(10):e69-e70.
  8. American Association of Oral and Maxillofacial Surgeons (AAOMS). Opioid prescribing: acute and postoperative pain management. https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/opioid_prescribing.pdf Accessed August 25, 2020.
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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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