Becker's Spine Review

Becker's Spine Review July 2017

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INFILTRATE WITH GREATER EXPAREL ® (bupivacaine liposome injectable suspension) has a broad indication that doesn't limit your use by surgery type or surgical site. It is indicated for administration into the surgical site to produce postsurgical analgesia. By providing long-lasting pain control with less need for opioids, EXPAREL may help you reduce the opioid burden to your patients. In our soft tissue trial, more EXPAREL patients were opioid-free compared with placebo patients: 28% vs 10%, respectively (P<0.0008).* If you want to use EXPAREL with bupivacaine HCl, you can administer both in the same syringe as long as the milligram dose ratio of bupivacaine HCI to EXPAREL does not exceed 1:2. *The clinical bene t of the decrease in opioid consumption was not demonstrated in pivotal trials. ©2016 Pacira Pharmaceuticals, Inc., Parsippany, NJ 07054 PP-EX-US-1975 12/16 Please see brief summary of Prescribing Information on reverse side. Full Prescribing Information is also available at www.EXPAREL.com. For more information, please visit www.EXPAREL.com or call 1-855-RX-EXPAREL (793-9727). Important Safety Information EXPAREL is contraindicated in obstetrical paracervical block anesthesia. In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting. 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. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. Warnings and Precautions Speci c to EXPAREL EXPAREL is not recommended for the following types or routes of administration: epidural, intrathecal, regional nerve blocks, or intravascular or intra-articular use. Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Formulations of bupivacaine other than EXPAREL should not be administered within 96 hours following administration of EXPAREL. 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 paresthesias. 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.

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