Becker's Hospital Review

DEMAND A NON-OPIOID OPTION FOR YOUR POSTSURGICAL PATIENTS Administered to more than 4 million patients since 2012, EXPAREL is now indicated for infi ltration and interscalene brachial plexus block. 4 In an infiltration study, EXPAREL significantly reduced pain and opioids versus bupivacaine HCl § 78% REDUCTION in overall opioid consumption (P<0.005) 13.6% REDUCTION in cumulative pain scores (P<0.04) 10% OF PATIENTS WERE OPIOID FREE WITH EXPAREL vs 0% with bupivacaine HCl (P<0.01) * According to a retrospective study of hospital discharge data (N=37,031). †According to a prospective, longitudinal study (N=109). Preoperative opioid use, self-perceived risk of addiction, and depression were each independent predictors of prolonged (6 months) opioid use after surgery. ‡ From an analysis of the 2008–2010 data in the National Survey on Drug Use and Health to examine patterns of heroin use and risk behaviors among past-year nonmedical users of opioid pain relievers. § In patients undergoing a TKA; reductions are measured through 48 hours. Rates and types of adverse events were similar between treatment groups. The most common adverse events in the EXPAREL group were nausea, muscle spasms, and vomiting. References: 1. Kessler ER, Shah M, Gruschkus SK, Raju A. Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes. Pharmacotherapy. 2013;33:383-391. 2. Carroll I, Barelka P, Wang CKM, et al. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg. 2012;115:694-702. 3. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002–2004 and 2008–2010. Drug Alcohol Depend. 2013;132:95-100. 4. Data on File. 4859. Parsippany, NJ: Pacira Pharmaceuticals, Inc.; May 2018. Indication EXPAREL is indicated for single-dose infi ltration in adults to produce postsurgical local analgesia and as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and e§ cacy have not been established in other nerve blocks. Important Safety Information EXPAREL is contraindicated in obstetrical paracervical block anesthesia. Adverse reactions reported with an incidence greater than or equal to 10% following EXPAREL administration via infi ltration were nausea, constipation, and vomiting; adverse reactions reported with an incidence greater than or equal to 10% following EXPAREL administration via interscalene brachial plexus nerve block were nausea, pyrexia, and constipation. If EXPAREL and other non-bupivacaine local anesthetics, including lidocaine, are administered at the same site, there may be an immediate release of bupivacaine from EXPAREL. Therefore, EXPAREL may be administered to the same site 20 minutes after injecting lidocaine. EXPAREL is not recommended to be used in the following patient population: patients <18 years old 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 Specifi c 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, 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. For more information, please visit www.EXPAREL.com or call 1-855-RX-EXPAREL (793-9727). Please see brief summary of Prescribing Information on adjacent page. Full Prescribing Information is also available at www.EXPAREL.com. THE PRESIDENT HAS DECLARED A PUBLIC HEALTH EMERGENCY. NOW WHAT? OPIOID CRISIS IN AMERICA S P O T L I G H T O N T H E FIND OUT MORE BY VISITING WWW.EXPAREL.COM AND REQUEST TO MEET WITH ONE OF OUR REPRESENTATIVES surgical patients prescribed an opioid may go on to long-term use or abuse 2 † 1in15 new heroin users started out by misusing opioid pain relievers 3‡ 4 of5 HOSPITAL OPERATING ROOMS ACROSS THE COUNTRY ARE FUNCTIONING AS UNINTENDED GATEWAYS TO OPIOID ADDICTION © 2 018 Pacira Pharmaceuticals, Inc., Parsippany, NJ 0 70 5 4 PP-E X-US-3 6 4 5 0 5 /18 99 % of surgical patients receive opioids to manage postsurgical pain 1 *

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