Exparel (bupivacaine liposomal) is a brand-name drug prescribed for pain relief after surgery in adults and some children. Exparel comes as an injection that’s given as a single dose by a healthcare professional.

Exparel is approved by the Food and Drug Administration (FDA) to treat pain after surgery in adults and children ages 6 years and older. It’s also approved for use in adults as a postsurgical nerve block in the following areas of the body:

  • interscalene brachial plexus (for surgeries of the shoulder, arm, or hand)
  • sciatic nerve block in the knee joint (for surgeries below the knee)
  • adductor canal block (for surgeries of the upper leg)

Exparel belongs to a drug class called local anesthetics. It’s not available in a generic version. Other forms of bupivacaine, the active ingredient in Exparel, are available as generic medications. But the liposomal form of bupivacaine in Exparel is only available as the brand-name product.

Keep reading for specific information about the dosage of Exparel, including its strength and how to receive the medication. For a comprehensive look at Exparel, see this article.

Note: This article describes typical dosages of Exparel provided by the drug’s manufacturer. However, your doctor will prescribe the Exparel dosage that’s right for you.

Read below for information about the typical dosages of Exparel and details about how it’s given.

Exparel form

Exparel comes as a liposomal suspension. This is a liquid mixture of bupivacaine in small, fat-like particles. This allows Exparel to be released over an extended period of time. The drug is given as an injection during surgery.

Exparel strength

Exparel comes in one strength of 13.3 milligrams per milliliter (mg/mL) of suspension (1.3%).

Typical dosages

The following information describes dosages that are commonly used or recommended in adults. Your doctor will determine the best dosage to fit your needs. These can include:

  • the type of surgery you’re having
  • the size of the surgical site
  • any health conditions you may have

Dosage for pain relief after surgery

Doctors may prescribe Exparel to treat pain after surgery. The recommended dose of Exparel ranges from 106 to 266 mg, given once. Your doctor will determine the dose that’s right for you.

The recommended maximum dose of Exparel for pain relief after surgery is 266 mg, given as a single dose.

For more information about your specific dosage, talk with your doctor.

Dosage for nerve block after surgery

Exparel is also used as a nerve block after surgery. In this case, the recommended dose is 133 mg given as a single dose. You’ll also likely take other medications for pain relief after surgery.

Talk with your doctor if you have questions about your dosage.

Children’s dosage

Exparel is approved to treat pain after surgery in children ages 6 years and older.

The dosage is based on the child’s body weight in kilograms (kg). One kg equals about 2.2 pounds (lb). The dosage per kg of body weight is measured in mg per kg (mg/kg) and is calculated by your child’s doctor.

The recommended dose of Exparel to treat postsurgical pain in children is 4 mg/kg of body weight, given as a single dose. The maximum dose of Exparel that’s been studied in children is 266 mg.

Talk with your child’s doctor if you have questions about their dosage.

How Exparel is given

Your doctor or another healthcare professional will inject your Exparel dose during your surgery. They inject the drug into the surgical area.

With a nerve block, your doctor will inject Exparel near one of three different nerves. The exact nerve area depends on your specific surgery.

If you have questions about what to expect with Exparel injections, talk with your doctor. There’s also information about how Exparel is given on the manufacturer’s website.

Length of treatment

Exparel is a short-term treatment. You’ll receive one Exparel injection during your surgery with no follow-up doses. The active ingredient (bupivacaine liposomal) releases slowly into the body, providing pain relief that typically lasts for several days.

Talk with your doctor if you have questions about Exparel or managing pain after surgery.

Your doctor will determine your Exparel dose and give you your injection. However, receiving more than the recommended amount may lead to harmful effects or overdose.

An overdose is generally related to the combined effect of local anesthetics used for pain management after surgery. (Exparel is a local anesthetic.) Overdose may also occur after an unintended injection of Exparel into a blood vessel.

Effects of an overdose

Overdose effects of Exparel can include:

If you receive more than the recommended amount of Exparel

Call your doctor right away if you believe you’ve received too much Exparel or you’re experiencing an Exparel overdose. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

Below are some frequently asked questions about Exparel and dosage.

Is there a dose calculator for Exparel?

Not really. Your doctor will determine your dose of Exparel based on the type of surgery you’re having. In clinical trials of the drug, a dose of 106 mg was given for removal of a bunion. And a dose of 266 mg was given for removal of hemorrhoids.

In children, the typical recommended dosage of Exparel is 4 mg/kg of body weight. Your child’s doctor will calculate the dose based on your child’s weight. The recommended dose is based on studies in which the drug was given for spine surgery and heart surgery.

For details about dose determinations, see the “Exparel dosage” section above. If you’d like more information, talk with your doctor.

Can you mix Exparel with other forms of bupivacaine?

Yes, doctors may give Exparel in combination with other bupivacaine forms if they follow what’s known as the “Exparel 50 rule.” This means that the amount of bupivacaine that’s given must be half the amount of Exparel that’s given. For example, if your dose of Exparel is 106 mg, then your dose of bupivacaine cannot be more than 53 mg.

The reason for this rule is bupivacaine is also the active ingredient in Exparel. It comes in liposomes (fat-like particles) that release the drug slowly into your body over time. Other injectable forms of bupivacaine don’t last as long as bupivacaine liposomal (Exparel). So with the Exparel 50 rule, the total level of bupivacaine in your body is within a safe and effective range for pain management.

If you have questions about combining different forms of bupivacaine, talk with your doctor.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.