Inpatient

EXPAREL in inpatient lumbar spinal fusion1

Study Objective: Evaluate the efficacy of EXPAREL in patients undergoing lumbar spinal fusion1

Investigator-initiated

Primary outcomes of interest1

icon postoperative opiod consumption
Postoperative opioid consumption
icon pain score
Postoperative pain measured using a VAS
icon length of stay
Length of stay
icon costs
Costs

Results

EXPAREL use resulted in reduced opioid use and shorter hospital stays after lumbar spinal fusion

The EXPAREL cohort had significantly less opioid usage and similar pain control compared with the non-EXPAREL cohort.

digram mean morphine

Patients in the EXPAREL cohort had a shorter length of stay and were more than twice as likely to be discharged within 2 days of surgery (88.6% vs 38.1%; P<0.05).

Patients in the EXPAREL cohort were 20 times more likely to walk within the first 12 hours after surgery (61% vs 3%; P<0.001).

diagram mean stay

EXPAREL use resulted in lower direct costs for lumbar spinal fusion

info costs

Total Pharmacy and Direct Costs

Despite a nominal increase in pharmacy expenses, EXPAREL had a 16% lower direct cost for the overall hospital stay ($17,425 vs $20,752; $3,327 difference).

diagram total pharmacy
  • This retrospective cohort study assessed adults who underwent posterior lumbar spinal fusion surgery between April 2015 and September 2016
  • Propensity score matching (1:1 ratio) was conducted between the EXPAREL cohort and the non-EXPAREL cohort based on age, sex, race, and CCI
  • The final cohort was composed of 105 EXPAREL patients and 105 non-EXPAREL patients
    • Patients were an average age of ~60 with a mean CCI of ~2.8; half were male (~50%), and the majority were white (~98%)
  • Baseline characteristics were well balanced between groups (P>0.05)
  • The sample size was relatively small and could not account for different injection techniques and admixtures of EXPAREL
  • A majority of the patients treated with EXPAREL had spinal fusions performed in the outpatient setting, which was not presented in the findings
  • The lower average pain score may have been attributed to nurses providing a generalized dosage of a narcotic that is typically administered in a similar patient population
  • Types or routes of administration and techniques used for EXPAREL or non-EXPAREL were not specified

CCI, continuous catheter infusion.

Reference: 1. Roh, et al. Clin Spine Surg. 2020;33(8):E359-E363.

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Important Safety Information

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia
Important Safety Information
Important Safety Information

Indication

EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.

Important Safety Information

  • EXPAREL is contraindicated in obstetrical paracervical block anesthesia
  • Adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via infiltration were nausea, constipation, and vomiting; adverse reactions reported in adults with an incidence greater than or equal to 10% following EXPAREL administration via nerve block were nausea, pyrexia, headache, and constipation
  • Adverse reactions with an incidence greater than or equal to 10% following EXPAREL administration via infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, vision blurred, pruritus, and tachycardia
  • Do not admix lidocaine or other non-bupivacaine local anesthetics with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine
  • EXPAREL is not recommended to be used in the following patient populations: patients <6 years old for infiltration, patients younger than 18 years old for nerve blocks, 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, sciatic nerve block in the popliteal fossa, and adductor canal 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

Please refer to full Prescribing Information.