I have used Exparel on 8 patients to date. All
had complete pain relief for 48-72 hours, except
one patient who claimed she had pain after 8
hours (I found this to be unbelievable, but
people vary). That said, we are trialing it at a
surgery center because of it costs about $250
per bottle 1.3% 20cc.
The Exparel can be diluted with 10 ml (up to
14ml) of .9% normal saline and then injected if
you need more volume and still want to not
exceed the maximum dose. We have been using this
as a trial - shaking the bottle, withdrawing the
Exparel with sterile technique from the bottle,
and them mixing the amount I need for a
particular case. Do not dilute the entire bottle
or it should be used in 4 hours. If I am doing 3
cases, then I will use the 20 ml bottle and
dilute accordingly or if there is another case
to follow, they may use the remainder.
Remember, Do Not use Lidocaine for at least 20
minutes before Exparel. I wait 30-60 minutes
before injecting the Exparel so it does not
distribute to rapidly. It can take some time to
start working so you need to account for that
based on your surgical time. Undiluted it is
rather thick and you will need at least a 25g or
larger needle. I always use a finger control for
aspiration during the injection, with Exparel
you do not want an intra vascular injection.
Other than that I have had excellent PO
analgesia and hope I can continue to use it as
the costs have my local hospitals requiring a
special order.
Gary Scheinin, DPM, Los Gatos, CA,
footdr12@comcast.net
