From the Guidelines
Exparel (liposomal bupivacaine) is not recommended as a first-line treatment for postoperative pain management in general surgery due to its high cost and uncertain clinical benefits compared to standard bupivacaine 1. The primary controversies surrounding Exparel include its cost-effectiveness, efficacy, and duration of action. Some studies have shown that Exparel may not provide superior pain control or reduce opioid consumption compared to standard anesthetics 1. Additionally, there are concerns about potential conflicts of interest in research supporting Exparel, with some studies funded by the manufacturer showing more favorable results than independent research. The FDA has also issued warnings about adverse events when Exparel is administered via certain routes. Multimodal, opioid-sparing analgesia approaches, such as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), lidocaine, dexmedetomidine, ketamine, and magnesium, may be more effective in reducing opioid requirements and improving postoperative recovery 1. Regional anaesthetic techniques, such as epidural analgesia, ultrasound-guided transversus abdominis plane block, and erector spinae plane block, have also been shown to be highly efficient in reducing opioid requirements. Therefore, a multimodal approach to pain management, incorporating a combination of these techniques, is recommended to improve postoperative recovery and reduce opioid consumption. Key considerations in the use of Exparel include:
- Cost-effectiveness: Exparel is significantly more expensive than standard bupivacaine, and its clinical benefits may not justify this price difference.
- Efficacy: The evidence for Exparel's superiority in pain control and opioid reduction is mixed, and some studies have shown no significant difference compared to standard anesthetics.
- Duration of action: The advertised 72-hour pain relief may not be consistently achieved in clinical practice.
- Potential conflicts of interest: Research supporting Exparel may be influenced by manufacturer funding, and independent studies may show less favorable results.
- Appropriate technique: Improper administration of Exparel may reduce its effectiveness, and the FDA has issued warnings about adverse events when administered via certain routes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Controversies with Exparel in General Surgery
- The use of Exparel, a long-acting liposomal bupivacaine local anesthetic agent, has been shown to have significant benefits in postoperative pain management, but its efficacy can be affected by factors such as pH levels, as seen in cases of inflamed tissue and acidic fluid pH 2.
- There is a concern about the variability in response to Exparel, with some studies showing inconsistent results, including the possibility of bimodal kinetics creating analgesic gaps 3.
- The use of Exparel in pediatric patients has been shown to be safe and effective in reducing postoperative pain and opioid use, but more studies are needed to confirm these findings 4.
- The combination of Exparel with other medications, such as meloxicam, has been shown to be beneficial in treating postoperative pain, but more research is needed to fully understand the effects of these combinations 2.
Potential Risks and Limitations
- Exparel has not yet been approved for use in regional anesthesia to prolong postoperative pain control, and more studies are needed to determine its safety and efficacy in this context 3.
- The use of Exparel may not be suitable for all patients, and individual results may vary depending on factors such as the type of surgery, patient demographics, and comorbidities.
- More research is needed to fully understand the potential risks and limitations of Exparel, including its potential interactions with other medications and its effects on different patient populations 5, 2, 3, 4.