Exparel Long-Acting Local Anesthetic: Still a Hot Topic
A major advance in pain relief
Exparel, the long-acting numbing agent that provides pain reduction for up to 3 days with many types of surgery, is still making the news. I came across it in 2011 and immediately recognized that it could be a major advance. I gave a talk on it at a session called “Hot Topics” held with our annual national plastic surgery meeting, as it turns out a month before it received FDA clearance. It has become increasingly popular for breast surgery and tummy tucks (abdominoplasty.
Less pain after surgery means better recovery
The use of local anesthetic injected directly into the surgical site has been used for decades. Even for procedures done under general anesthesia, having a numbing effect in the surgical area when the patient wakes up is obviously a good thing. Unfortunately, most of these last for only a few hours. Exparel takes a local anesthetic called bupivacaine and encapsulates in lipid nanospheres, which release it slowly over 72 hours. Ongoing studies with Exparel (some of which we participated in) have confirmed that patients have less pain. Just as important, this means less reliance on opioid drugs like Percocet or Vicodin. Opioids are a godsend for patients experiencing pain, but they can have very unpleasant side-effects including nausea, constipation, and impaired mental function. And it’s no secret that the country is in the midst of a crisis of opioid dependency, with surgery as a triggering event for many. So: less pain, less need for opioids, better patient experience. (Inexplicably, some hospitals have taken Exparel off of their formulary – the approved list of medications available – because it is cheaper to give a supply of narcotics and send the patient home.)
Exparel one of the best Hot Topics of the past decade
At the recent meeting of the American Society for Aesthetic Plastic Surgery, a special session was held called “Best of Hot Topics” for the past 10 years. Of the several hundred presentations of the past decade of Hot Topics, Exparel was one of the seven selected. I was pleased to present it again and provide an update. One of the important advances is in techniques for placement of the injections, especially the use of the TAP block with tummy tucks. The hot question now is why it isn’t used more.