6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5
W
hen attempting to control
post-operative pain, which
drug is better — bupiva-
caine, at a price of about
$2.80 per vial, or the lipo-
somal bupivacaine formulation trade-named Exparel,
at about $285 per vial?
For the price, Exparel should be lights-out better.
But it's not clear if Pacira Pharmaceuticals' flagship
pain medication is even slightly superior at control-
ling post-op pain than conventional local anesthetics. An examination of
Exparel's clinical trial data, the FDA's evaluation of those data and a patchwork
of post-approval studies show very little difference between the performance of
liposomal bupivacaine and standard bupivacaine.
"And at $285 for a dose of Exparel versus $2.80 for a shot of bupivacaine,
Which One Provides
Better Pain Relief?
Dan O'Connor
Editor-in-Chief
What we found may surprise you.
Examining
Exparel's Effectiveness
It sounds like a great concept.
Encapsulate bupivacaine in tiny
bubbles made out of the same
material as a cell membrane, and
inject it into the muscles and soft
tissues around the surgical
wound. Like soap bubbles in a
dishpan, these bubbles will burst
slowly and predictably, releasing
the pain-numbing medication
over 72 hours for up to 3 days of
pain control. No pumps, no
catheters, no opioids. That's the
promise of Exparel. Many studies,
however, have found no signifi-
cant benefit from using liposomal
bupivacaine instead of standard
bupivacaine in periarticular injec-
tions as part of a multimodal pain
management strategy.
