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not been published and so it is apparently not peer-reviewed. It is a single-center
study. It's not known whether the investigators or patients were blinded. No
information is available on how the patients were selected. And Dr. Barrington
also has a consulting relationship with Pacira.
Another single-center 60-patient study awaiting publication pits 0.25% bupiva-
caine against Exparel for subcostal TAP blocks for hysterectomy. The study
showed that the Exparel patients used only half the opioids that the bupivacaine
patients did — 3 Percocet per day instead of 6 — and also showed that they had
lower minimum and maximum pain scores. But the controls received less than
two-thirds of the medication that the study patients did. Average pain scores
weren't reported. The study is small. And once again, it was designed by a Pacira
consultant.
Many surgeons became enthusiastic about Exparel, and many still are. By the
end of 2014, Pacira had sold $189 million worth of Exparel, more than doubling
the $76 million the drug had brought in the year before.
Storm clouds
But trouble was on the horizon. Other studies, particularly those whose authors
had no relationship with Pacira, were critical.
A review by 5 pharmacists published in Hospital Pharmacy in 2014 was high-
ly skeptical of Exparel's value. The authors said Exparel's clinical trials had
shown no statistical differences in pain scores. "The use of a new product is jus-
tifiable when it fulfills an unmet need or the increased cost is offset by
improved outcomes over current standard," says the study. "However, based on
the available data, bupivacaine liposomal does not meet such a need."
In 2015, a study in Pharmacotherapy testing Exparel against no drug in a mul-
timodal setting in total knee patients found no statistical difference in pain
scores between the group that received Exparel and the group that did not. The
Exparel group did take fewer opioids than the control group.
