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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.
The recommended dose of EXPAREL for 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 (20 mL). The recommended dose of EXPAREL for patients aged 6 to <17 years is 4 mg/kg, up to a maximum of 266 mg (20 mL). The recommended dose of EXPAREL in adults for interscalene brachial plexus nerve block and sciatic nerve block in the popliteal fossa is 133 mg (10 mL). The recommended dose of EXPAREL in adults for an adductor canal block is 133 mg (10 mL) admixed with 50 mg (10 mL) 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 (maintain a minimum concentration of 0.89 mg/mL) with normal (0.9%) saline or lactated Ringer’s solution.
A linear ultrasound transducer was placed in a transverse orientation over the anteromedial thigh at the midpoint between the inguinal crease and the patella. The femoral artery was observed centered beneath the sartorius muscle. The saphenous nerve was visualized anterolateral to the femoral artery; the nerve to vastus medialis was not visualized.
A nerve stimulator was connected to a 21G 100-mm block needle and the current intensity set to 0.8-1.0 mA.
After skin preparation and using sterile technique, the needle was advanced in-plane from the lateral aspect aiming for the femoral artery in a trajectory that traveled just deep to the sartorius muscle. An assistant placed a hand on the medial vastus muscle just proximal to the knee in order to detect a motor response (“twitch”).
The needle was directed in the subsartorial plane until a motor response of the medial vastus muscle was observed and felt. A small bolus (2 mL) of saline was then slowly injected to confirm the location of the nerve to vastus medialis, followed by 10 mL of the local anesthetic mixture.
The needle was then carefully redirected to the saphenous nerve, passing through the vastoadductor membrane, and another 2 mL of saline injected to confirm spread immediately adjacent to the saphenous nerve. The remaining 10 mL of local anesthetic mixture was then administered at this location.
ADDITIONAL NOTES
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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