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New Data Show EXPAREL Plays a Key Role in Achieving Significant Reductions in Opioid Use, Hospital Stay and Total Hospitalization Costs Following Painful Knee Replacement Surgery
This retrospective analysis utilized hospital chargemaster data from the Premier Healthcare Database from
Results showed that patients undergoing TKA who received EXPAREL demonstrated a significant:
- Decrease in opioid consumption, expressed in oral morphine equivalent dosing (MED), when controlled for LOS in both the
Medicareand commercial insurance groups (69 mg MED and 64 MED reductions, respectively; P<0.0001)
- Decrease in average hospital LOS by 0.6 days in both the
Medicareand commercial insurance groups (P<0.0001)
- Decrease in total hospitalization costs in both the
Medicareand commercial insurance groups (–$616 and –$775, respectively; P<0.0001)
- Increase in likelihood to be discharged home in both the
Medicareand commercial insurance groups (1.58 times more likely and 1.63 times more likely, respectively; P<0.0001)
“TKA is a painful surgical procedure, and inadequate pain control can delay recovery and increase hospital length of stay, opioid consumption and total hospitalization costs,” said
Results of this study are consistent with findings from several retrospective studies and randomized controlled trials with high internal validity, including the PILLAR trial,2 which found that EXPAREL demonstrated a 78 percent decrease in opioid consumption and significantly better pain control with infiltration of EXPAREL plus bupivacaine versus bupivacaine alone.
“We are pleased to see another body of data that is representative of the positive impact EXPAREL continues to show in joint replacement procedures,” said
Approximately 700,000 total knee arthroplasty (TKA) procedures were performed in
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 infiltration 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 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, 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. Full Prescribing Information is available at www.EXPAREL.com.
Coyne Public Relations
2 Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2018;33(1):90-96. doi:10.1016/j.arth.2017.07.024.
3 Fingar KR, Stocks C, Weiss AJ, et al. Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012: Statistical Brief #186.
4 Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in