Exparel is a brand-name prescription drug. It’s an injection (shot) used to provide pain relief after you’ve had surgery.

Specifically, the drug is FDA-approved for these uses:

  • Local analgesia. For local analgesia, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain. For this use, Exparel can be given to adults and children ages 6 years and older.
  • Nerve block. As a nerve block, Exparel is used to block certain nerves from sending pain signals inside your body. Exparel is approved for this use if you have surgery on an area of your body that’s affected by the brachial plexus. (The brachial plexus is a set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.) For this use, Exparel is given to adults.

Drug details

Exparel contains the active drug bupivacaine. It’s available in 10-mL and 20-mL single-dose vials. Exparel comes in one strength: 13.3 milligrams per milliliter (mg/mL).

Exparel is given as an injection by healthcare professionals. It’s administered at the time of surgery to provide pain relief as you recover.

Effectiveness

For information on the effectiveness of Exparel for its approved uses, see the “Exparel uses” section below.

Bupivacaine, the active drug in Exparel, is available as a generic medication. (A generic drug is an exact copy of the active drug in a brand-name medication.)

However, Exparel is only available as a brand-name medication. It’s not currently available in generic form.

Exparel vs. generic bupivacaine

Generic bupivacaine medications come in different formulations than Exparel.

Exparel is formulated to slowly release its active drug, providing pain relief that lasts for several days. Exparel’s slow-release formulation is known as a liposomal injection. It carries the active drug in small, fat-like particles that are absorbed in the body.

Exparel can cause mild or serious side effects. The following lists contain some of the key side effects that may occur after you’ve received Exparel. These lists don’t include all possible side effects.

For more information on the possible side effects of Exparel, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Exparel, you can do so through MedWatch.

Mild side effects

Mild side effects of Exparel can include:*

  • constipation
  • dizziness
  • itchiness
  • pain in your back or neck
  • tiredness
  • anxiety
  • trouble sleeping
  • altered ability to taste
  • muscle twitching
  • nausea and vomiting†
  • fever†

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Exparel. To learn about other mild side effects, talk with your doctor or pharmacist, or view Exparel’s prescribing information.
† These mild side effects are discussed further in the “Side effects details” section below.

Serious side effects

Serious side effects from Exparel aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Anemia (low red blood cell level). Symptoms can include:
    • weakness
    • tiredness
    • pale skin
  • Swelling in your arms or legs. Symptoms can include:
    • stretched or shiny skin
    • puffiness of the skin on your arms, legs, hands, or feet
    • skin that stays dimpled if it’s pressed for a few seconds
  • Changes in blood pressure, making it either too high or too low. Symptoms can include:
    • chest pain
    • sweating
    • tiredness
    • vision problems
  • Loss of cartilage in your joints. Symptoms can include:
    • joint pain
    • joint stiffness
  • Abnormal heart rhythm. Symptoms can include:
    • chest pain
    • dizziness
    • shortness of breath
  • Urinary retention. Symptoms can include:
    • trouble starting to urinate
    • having a dribble or weak stream of urine
    • inability to empty your bladder
  • Methemoglobinemia (a certain blood disorder). Symptoms can include:
    • skin discoloration
    • lightheadedness
    • weakness
    • seizures
  • Allergic reaction.*
  • Numbness.*
  • Falling.*

* These serious side effects are discussed further in the “Side effect details” section below.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Exparel. But it’s not known exactly how many people have had a reaction to Exparel.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Exparel. But call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Nausea and vomiting

You may feel nauseous or have vomiting after receiving Exparel.

For example, in clinical studies of people who received treatment for local analgesia:*

  • 2.1% to 40.2%† of people who took Exparel had nausea
  • 1.1% to 37.5%† of people who took a placebo (treatment with no active drug) had nausea
  • 2.1% to 27.8%† of people who took Exparel had vomiting
  • 4.3% to 17.7%† of people who took a placebo had vomiting

* Local analgesics are injected into certain areas of your body to numb them so that you don’t feel pain.
† This percentage range varied depending on the type of surgery they had.

And in clinical studies of people who received treatment for a nerve block:*

  • 36.9% of people who took Exparel had nausea
  • 37.3% of people who took a placebo had nausea
  • 10.1% to 18.3%† of people who took Exparel had vomiting
  • 20.4% of people who took a placebo had vomiting

* Nerve blocks are injected into certain areas of your body to stop certain nerves from sending pain signals.
† This percentage range varied depending on the dose of treatment they received.

Keep in mind that many people can feel nauseous or have vomiting during or after surgery, which is when Exparel may be given. Nausea and vomiting may be related to the procedure that’s been done. Or these symptoms may result from certain medications that were given, including Exparel.

Your doctor will monitor you closely after your surgery. Be sure to tell them if you feel nauseous or have vomiting while you’re recovering. They may be able to give you medication to help reduce your discomfort.

If you have nausea or vomiting that doesn’t go away 24 to 48 hours after your surgery, call your doctor right away. Your symptoms may be a sign of a more serious issue, such as infection.

Fever

Some people have a fever after receiving Exparel. For example, in clinical studies, fever occurred in:

  • 1.1% to 23.3%* of people who received Exparel
  • 0% to 17.9%* of people who received a placebo (treatment with no active drug)

* This percentage range varied based on the type of procedure they had done and the dose of Exparel they received.

It’s important to remember that Exparel is given at the time of surgery to help reduce pain as you recover. And many people have a fever following surgery. However, call your doctor right away if:

  • you have a fever that doesn’t go away, or
  • you have a fever that begins several days after your surgery

Your doctor may need to examine you and check to see what’s causing your fever. In some cases, fever can be a sign of a serious complication, such as infection.

Numbness

Bupivacaine, the active drug in Exparel, is used to numb certain areas of your body so that you don’t feel pain. Because of this, it’s normal to feel numb in the area where your doctor injects Exparel.

Your doctor can tell you where it’s normal for you to feel numb and for how long you’ll have this feeling after you’ve received Exparel.

However, if you have numbness that spreads into areas of your body where you didn’t receive Exparel, call your doctor right away. If your condition feels life threatening, call 911 or your local emergency number.

Falling

During clinical studies, falls were a common side effect in people who received Exparel as a nerve block. (Nerve blocks are injected into certain areas of your body to stop certain nerves from sending pain signals.)

For example, in these studies, falls occurred in:

  • 2.4% to 2.7%* of people who received Exparel
  • 0.3% of people who received the placebo (treatment with no active drug)

* This percentage range varied depending on the dose of Exparel they received.

However, falls weren’t reported in clinical studies of people who received Exparel as a local analgesic. (Local analgesics are injected into certain areas of your body to numb them so that you don’t feel pain.)

If you fall after receiving Exparel, talk with your doctor. Your doctor will determine whether your fall is related to receiving the drug or not. And they can recommend how to best manage falls.

Other side effects of Exparel that may lead to falls

It’s important to note that Exparel can cause certain side effects that may lead to falls. These side effects include:

  • dizziness
  • low blood pressure
  • weakness
  • muscle twitching
  • numbness in the area where Exparel was given

If you have any of these side effects, and you’re concerned about your risk of falling, talk with your doctor. They can recommend ways to help keep you safe while you’re using Exparel.

The Exparel dosage your doctor prescribes will depend on several factors. These include:

  • the type of surgery or procedure you’re having
  • the size of the surgical site or body area that needs pain relief

The following information describes dosages that are commonly used or recommended. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Exparel comes as a liquid that’s given as an injection by healthcare professionals.

Exparel comes in 10-mL and 20-mL single-use vials. It’s available in one strength: 13.3 milligrams per milliliter (mg/mL) or 1.3%.

Dosage for pain management after surgery

Exparel is given as one injection at the time of your surgery. Your doctor will determine the dose of Exparel that’s right for you depending on the type of surgery you’re having. Your Exparel dose will also depend on how large the area is that’s affected by your surgery.

For example, in clinical studies, the following doses of Exparel were used:

The maximum recommended dose of Exparel as a local analgesic* is 266 mg (20 mL). And the maximum recommended dose of Exparel as a nerve block† is 133 mg (10 mL).

* As a local analgesic, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain.
† As a nerve block, Exparel is used to block certain nerves from sending pain signals inside your body.

Children’s dosage

For children, Exparel dosages for local analgesia* are determined by the child’s body weight. The usual recommended dose is 4 mg of drug per kilogram (kg) of body weight. (One kilogram is equal to about 2.2 pounds.)

The maximum recommended dose in children is 266 mg of Exparel.

* As a local analgesic, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain.

Will I need to use Exparel long term?

No, Exparel isn’t meant to be used as a long-term treatment. Instead, it’s used short term to provide pain relief as you recover from certain surgeries.

Exparel is used to provide pain relief as you recover from surgery. It works by decreasing pain signals that are sent from the site of your surgery to your brain and spinal cord. The drug numbs the affected area and reduces how much pain you feel.

Exparel contains the active drug bupivacaine. It’s formulated to slowly release the active drug, providing pain relief that lasts for several days.

How long does it take to work?

How quickly Exparel begins to work will vary from person to person. But Exparel generally starts working within 30 minutes after it’s given.

How long does Exparel’s effect last? When does Exparel wear off?

How long Exparel’s effects last varies from person to person.

In clinical studies, pain relief provided by Exparel lasted from 24 to 72 hours. However, this will vary depending on the type of surgery you have and the dose of Exparel you receive.

The Food and Drug Administration (FDA) approves prescription drugs such as Exparel to treat certain conditions. Exparel may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Exparel for pain management after surgery

Exparel is FDA-approved to reduce pain after surgery. The drug is administered during surgery to provide pain relief as you recover.

Specifically, Exparel is approved for these uses:

  • Local analgesia. For local analgesia, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain. For this use, Exparel is given to adults and children ages 6 years and older.
  • Nerve block. As a nerve block, Exparel is used to block certain nerves from sending pain signals inside your body. Exparel is approved for this use if you have surgery on an area of your body that’s affected by the brachial plexus. (The brachial plexus is a set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.) For this use, Exparel is given to adults.

Note: It’s not known whether it’s safe or effective to use Exparel for nerve blocks in areas of the body other than the brachial plexus.

When you have surgery, there’s usually tissue damage and inflammation at the site of your procedure. Exparel works to decrease pain after many types of surgeries, including:

Effectiveness of Exparel for pain management after surgery

In clinical studies, Exparel was effective in relieving people’s pain as they recovered from surgery.

For example, Exparel was studied in adults who had a bunion removal. In this study, some people received 106 mg of Exparel after their surgery. Other people received a placebo (treatment with no active drug). In the first 24 hours after surgery, people who took Exparel had significantly lower pain scores compared with people who took the placebo.

A different study looked at people who had a hemorrhoid removal. After surgery, some people received 266 mg of Exparel, while other people received a placebo. For up to 72 hours after surgery, people who took Exparel had significantly lower pain scores compared with people who took the placebo.

Another clinical study looked at people who had either rotator cuff repair or total shoulder arthroplasty (joint repair). Prior to surgery, some people received 133 mg of Exparel as a nerve block. Other people received a placebo injection. For up to 48 hours after surgery, people who received Exparel had significantly lower pain scores compared with people who received the placebo.

Exparel and children

Exparel is approved for use as a local analgesic in children ages 6 years and older. As a local analgesic, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain.

Here are answers to some frequently asked questions about Exparel.

Exparel is used as a nerve block, but is it used as a TAP block?

Exparel is approved for use as a nerve block in certain nerves in your body. As a nerve block, the drug is used to stop certain nerves from sending pain signals from one area of your body to your brain and spinal cord.

Exparel is approved for this use in nerves located in your brachial plexus. (The brachial plexus is a set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.) If you’ve had surgery on an area of your body that’s affected by the brachial plexus, your doctor may inject Exparel into the area to help relieve pain.

However, with a transversus abdominus plane (TAP) block, a numbing medication is injected into nerves in your abdominal wall. Exparel isn’t approved for that use. It’s only approved for use as a nerve block in your brachial plexus.

Exparel is currently being studied to see if it’s effective as a TAP block. But more information is needed to determine whether Exparel should be used in this way. At this time, it’s not known whether Exparel is safe or effective for use as a nerve block in areas of your body other than the brachial plexus.

Is Exparel an anesthetic?

Yes, Exparel belongs to a group of drugs called anesthetics. But more specifically, Exparel is called an analgesic.

Anesthetic drugs are used to numb certain areas of your body so that you lose sensation in those areas. Analgesics, which are a type of anesthesia, are used to both numb and block pain in certain areas of your body.

Some anesthetic drugs cause you to fall asleep or lose consciousness. But Exparel doesn’t do that. Instead, it works by numbing and reducing pain in the area of your body where it’s injected.

Is Exparel an opioid?

No, Exparel isn’t an opioid. Opioids are a group of medications that work on certain receptors (attachment sites) on cells within your body.

Examples of opioids include:

  • morphine (Kadian, MS Contin, others)
  • oxycodone (Roxicodone, Oxycontin, others)
  • hydromorphone (Dilaudid)

Exparel works differently than opioids do. It doesn’t affect your body’s opioid receptors. Instead, Exparel works by numbing the area of your body where it’s injected.

Unlike opioids, which can affect your entire body, Exparel only affects the tissue or nerves that it’s injected into. Additionally, while opioids may cause dependence in some people, Exparel isn’t likely to do that. (With dependence, your body needs the drug in order for you to feel normal.)

Can I use Exparel with other pain medications?

Yes, in some cases, your doctor may prescribe other pain medications in addition to Exparel. These other medications can work with Exparel to help relieve pain as you’re recovering from surgery.

For information about other drugs that may be used with Exparel, see the “Exparel use with other drugs” section below.

And if you have questions about using other pain medications with Exparel, talk with your doctor.

When should I talk with my doctor about using Exparel?

It’s important to talk with your doctor about using Exparel before the date of your surgery. This drug can be used to help manage pain following your procedure. But it’s typically given during your surgery.

If you’re interested in using Exparel, talk with your doctor about it during your presurgery visit. They can advise whether this drug is right for your unique situation.

Where is Exparel injected?

Exparel is injected into the area of your body where you’re having surgery. The drug helps to provide pain relief as you recover from surgery.

To find out exactly where Exparel will be injected for your surgery, talk with your doctor. They’ll be able to provide this information based on the type of surgery you’re having.

What is a pain pump? Is Exparel given through a pain pump?

A pain pump is used to administer certain drugs directly to your spinal cord to help reduce pain. Pain pumps are placed surgically. They can be used for a short period of time (only up to 24 hours after your surgery) or for a long period of time (months or years).

Exparel isn’t administered using a pain pump. Instead, it’s injected into the area of your body where you’re having surgery.

In some cases, your doctor may recommend using certain drugs with a pain pump rather than using Exparel. They’ll do this if they feel the drugs given by a pain pump will work better for you than Exparel will.

It’s important to discuss pain management options with your doctor before your surgery date. They’ll advise a plan that’s best for your care.

Other drugs are available that may be used to relieve pain after you’ve had surgery. Some may be a better fit for you than others. If you’re interested in finding an alternative to Exparel, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Examples of other drugs that may be used to treat pain after surgery include:

  • local analgesics,* such as:
    • lidocaine (Xylocaine, Xylocaine-MPF, Lidoject, others)
    • bupivacaine (Marcaine, Sensorcaine-MPF, others)
    • ropivacaine (Naropin)
    • procaine
  • systemic pain medications,† such as:
    • opioids, including hydromorphone (Dilaudid) and morphine (Kadian, MS Contin, others)

* Local analgesics are injected into certain areas of your body to numb them so that you don’t feel pain.
† Systemic medications are drugs that affect your whole body.

Exparel is approved for use as a local analgesic and as a nerve block. With either use, the drug is given to provide pain relief as you recover from certain surgeries.

As a local analgesic, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain.

And as a nerve block, Exparel is used to stop certain nerves from sending pain signals inside your body. Specifically, Exparel is approved for this use in nerves located in the brachial plexus. (The brachial plexus is a set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.)

Sometimes, Exparel is used in combination with other medications to provide better pain relief for you. Below, we describe some of these drug combinations.

If you have questions about using other drugs with Exparel, talk with your doctor.

Note: Exparel shouldn’t be mixed and injected with local anesthetics* that don’t contain bupivacaine. (Bupivacaine is the active drug in Exparel.) If this occurs, the active drug in Exparel is released too quickly in your body. And this can alter how well Exparel works for you.

* Local anesthetics are drugs that cause numbing in certain areas of the body. Analgesics, such as Exparel, are a type of anesthetic that are used to both numb and reduce pain.

Exparel 50 rule

In some cases, your doctor may prescribe Exparel in combination with another medication that also contains bupivacaine. This combination of drugs is acceptable, as long as the ratio of bupivacaine to Exparel doesn’t exceed 1:2. In other words, the amount of bupivacaine that’s used shouldn’t be more than 50% of the amount of Exparel that’s used.

For example, if 133 mg of Exparel is used, no more than 66.5 mg of bupivacaine should be added to it.

Exparel cocktail

Exparel may be given with certain other medications used for pain or inflammation. This combination of drugs is sometimes called an “Exparel cocktail” or “pain cocktail.” In this case, Exparel and the other drugs may be given at the site of your surgery in one injection or separately as two injections.

The medications included in an Exparel combination depend on the type of procedure you’re having. They also vary depending on whether your doctor prefers to use certain drugs over others.

Examples of drugs that are sometimes used in combination with Exparel include:

As with all medications, the cost of Exparel can vary. The actual price you’ll pay depends on your insurance plan, your location, and the medical facility where you receive Exparel.

Before approving coverage for Exparel, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Exparel, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Exparel, or if you need help understanding your insurance coverage, reach out to your insurance company. They can help you find out if there are any financial assistance options available.

Generic version

Exparel isn’t available in a generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Generics tend to cost less than brand-name drugs.

You may wonder how Exparel compares with other medications that are prescribed for similar uses. Here we look at how Exparel and Marcaine are alike and different.

Ingredients

Both Exparel and Marcaine contain the same active drug: bupivacaine. However, Exparel and Marcaine aren’t formulated in the same way. Because of this, they release the drug differently inside your body.

Exparel is made from liposomal bupivacaine, while Marcaine is made from non-liposomal bupivacaine. Exparel releases its active drug more slowly in your body than Marcaine does.

Uses

Both Exparel and Marcaine are approved as local analgesics to relieve pain after you’ve had surgery. For this use, either drug is injected into certain areas of your body to numb them so that you don’t feel pain.

Exparel is approved for this use in adults and children ages 6 years and older. And Marcaine is approved for use in adults and children ages 12 years and older.

In addition, Exparel is approved for use as a nerve block to relieve pain after you’ve had surgery. (Nerve blocks stop certain nerves from sending pain signals inside your body.)

Specifically, Exparel is approved for this use if you have surgery on an area of your body that’s affected by the brachial plexus (The brachial plexus is the set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.)

Note: It’s not known whether it’s safe to use Exparel for nerve blocks in areas of the body other than the brachial plexus.

Marcaine is also approved for use as a regional anesthetic (anesthesia that numbs a larger area of your body than local anesthesia does). Regional anesthesia is often used for certain surgeries.

Drug forms and administration

Exparel comes as a liquid inside single-dose vials. It’s given as an injection by healthcare professionals.

Marcaine comes in vials of several different strengths and sizes. Marcaine injections are also given by healthcare professionals.

Side effects and risks

Exparel and Marcaine both contain bupivacaine. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Exparel, with Marcaine, or with both drugs (when taken individually).

  • Can occur with Exparel:
    • constipation
    • itchiness
    • muscle twitching
  • Can occur with Marcaine:
    • few unique mild side effects
  • Can occur with both Exparel and Marcaine:
    • nausea and vomiting
    • dizziness
    • pain in your back or neck
    • tiredness

Serious side effects

These lists contain examples of serious side effects that can occur with Exparel, with Marcaine, or with both drugs (when taken individually).

Effectiveness

Exparel and Marcaine have different approved uses, but they’re both used as local analgesics for pain relief following surgery.

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Exparel and Marcaine to be effective in relieving pain after surgery.

Costs

Exparel generally costs more than Marcaine. The actual price you’ll pay for either drug depends on your insurance plan and your location. It also varies based on costs related to seeing your healthcare professional to receive injections of either drug.

Exparel is a brand-name medication. There’s currently no generic form available for this medication. (A generic drug is an exact copy of the active drug in a brand-name medication.) Marcaine is a brand-name drug that’s also available as generic medications.

Generics usually cost less than brand-name drugs.

You may wonder how Exparel compares with other medications that are prescribed for similar uses. Here we look at how Exparel and lidocaine are alike and different.

Ingredients

Exparel is a brand-name medication that contains the active drug bupivacaine. It’s an anesthetic* that’s used to numb certain areas of your body and provide pain relief.

Lidocaine is also an anesthetic drug. However, it’s available as a generic medication and as the active drug in several brand-name medications. Lidocaine comes as the following brand-name medications:

  • Lidoderm
  • Lignospan Forte
  • Synera
  • Xylocaine
  • many others

* Local anesthetics are drugs that cause numbing in certain areas of the body. Analgesics, such as Exparel, are a type of anesthetic that are used to both numb and reduce pain.

Uses

Exparel is approved for use in adults to manage pain after surgery. Specifically, the drug is approved for these uses:

  • Local analgesic. For local analgesia, Exparel is injected into certain areas of your body to numb them so that you don’t feel pain. For this use, Exparel is given to adults and children ages 6 years and older.
  • Nerve block. As a nerve block, Exparel is used to block certain nerves from sending pain signals inside your body. Specifically, Exparel is approved for this use if you have surgery on an area of your body that’s affected by the brachial plexus. (The brachial plexus is a set of nerves that sends signals between your spinal cord and your shoulder, arm, or hand.) For this use, Exparel is given to adults.

Note: It’s not known whether it’s safe to use Exparel for nerve blocks in areas of the body other than the brachial plexus.

Lidocaine is also approved for use as local anesthesia, which includes analgesia, and brachial plexus nerve block. And like Exparel, it can be used in both adults and children.

In addition, lidocaine is approved for other regional anesthesia uses, such as:

  • central neural nerve block, which is placed directly into areas that affect the spinal cord
  • intercostal (between the ribs) nerve block

Drug forms and administration

Exparel comes as a liquid inside single-dose vials. It’s given as an injection by healthcare professionals.

Lidocaine comes in vials of several different strengths and sizes. Lidocaine injections are also given by healthcare professionals.

Side effects and risks

Exparel and lidocaine are both anesthetics. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Exparel, with lidocaine, or with both drugs (when taken individually).

  • Can occur with Exparel:
    • constipation
    • itchiness
    • tiredness
  • Can occur with lidocaine:
    • no unique mild side effects
  • Can occur with both Exparel and lidocaine:
    • nausea and vomiting
    • dizziness
    • muscle twitching
    • pain in your back or neck

Serious side effects

These lists contain examples of serious side effects that can occur with Exparel, with lidocaine, or with both drugs (when taken individually).

Effectiveness

These drugs haven’t been directly compared in clinical studies. But separate studies have found both Exparel and lidocaine to be effective as a local analgesia and brachial plexus nerve block.

Costs

Lidocaine generally costs less than Exparel costs. The actual price you’ll pay for either drug depends on your insurance plan and your location. It also varies based on costs related to seeing your healthcare professional to receive injections of either drug.

Exparel is a brand-name drug. There’s currently no generic form available for this medication. (A generic drug is an exact copy of the active drug in a brand-name medication.) However, generic forms of lidocaine are available. In addition, lidocaine is available as several brand-name medications.

Generics usually cost less than brand-name drugs.

It’s not known whether it’s safe to drink alcohol after receiving Exparel. If you drink alcohol, talk with your doctor before consuming alcohol around the time you’ll be getting Exparel.

Exparel can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Exparel and other medications

Below are lists of medications that can interact with Exparel. These lists don’t contain all the drugs that may interact with Exparel.

Before taking Exparel, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Exparel and other local anesthetics

Using Exparel in combination with other drugs that cause similar effects can increase side effects of Exparel. Because of this, it’s recommended that you don’t receive any other local anesthetics* for at least 96 hours after you’ve received Exparel.

Examples of other local anesthetics include:

  • lidocaine (Xylocaine, Xylocaine-MPF, Lidoject, others)
  • bupivacaine (Marcaine, Sensorcaine-MPF, others)
  • ropivacaine (Naropin)
  • procaine (Novocain)

Additionally, Exparel shouldn’t be mixed and injected with local anesthetics that don’t contain bupivacaine. (Bupivacaine is the active drug in Exparel.) If this occurs, the active drug in Exparel is released too quickly in your body. And this can alter how Exparel works for you.

* Local anesthetics are drugs that cause numbing in certain areas of the body. Analgesics, such as Exparel, are a type of anesthetic that are used to both numb and reduce pain.

Exparel and other drugs that cause methemoglobinemia

Exparel can cause a side effect called methemoglobinemia. With this blood disorder, you have too much methemoglobin in your blood. And your tissues don’t receive enough oxygen from your blood.

If you’re using Exparel, it’s important that you don’t receive any other medications that can also cause methemoglobinemia. Doing so can increase your risk of this side effect.

Examples of other medications that may cause methemoglobinemia include:

  • anticonvulsants, such as:
    • phenobarbital
  • nitrates, such as:
    • nitroprusside (Nitropress)
  • antimalarial medications, such as:
    • chloroquine
    • primaquine

If you have questions about using medications that may increase your risk for methemoglobinemia, talk with your doctor.

Exparel and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Exparel. However, you should still check with your doctor or pharmacist before using any of these products around the time when you receive Exparel.

Exparel and foods

There aren’t any foods that have been specifically reported to interact with Exparel. If you have any questions about eating certain foods around the time when you receive Exparel, talk with your doctor.

You’ll receive injections of Exparel from your doctor or healthcare professional. This drug is used to provide pain relief as you recover from surgery.

How it’s injected

Typically, Exparel is injected into the area of your body where you’re having surgery. Exactly how Exparel is injected into your body depends on the surgery you’re having and your doctor’s preferences.

When it’s injected

Injections of Exparel are given during your surgery. Because the drug releases slowly inside your body, you shouldn’t need any additional doses of the drug after surgery. Instead, Exparel should continue to provide pain relief for a few days after it’s given.

It’s not known whether Exparel is safe to use during pregnancy. In animal studies, some harm was seen in newborn offspring exposed to the drug during development. However, animal studies don’t always predict what will happen in humans.

If you’re pregnant or planning to become pregnant, talk with your doctor before receiving Exparel. They can discuss with you the risks and benefits of receiving this drug.

It’s not known if Exparel is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Exparel.

For more information about using Exparel during pregnancy, see the “Exparel and pregnancy” section above.

There’s not enough information available to know whether bupivacaine is safe to use while you’re breastfeeding. (Bupivacaine is the active drug in Exparel.)

Some reports show that small amounts of bupivacaine can be passed into human breast milk. But it’s not known what effect this may have on a child who’s breastfed.

If you’re breastfeeding and planning to use Exparel, talk with your doctor. They can discuss with you the risks and benefits of using this drug.

Before taking Exparel, talk with your doctor about your health history. Exparel may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Heart problems. Exparel can cause changes in your blood pressure and heart rhythm. If you already have certain heart problems, using Exparel could worsen them. For more information about this, see the “Exparel side effects” section above.
  • Allergic reaction. If you’ve had an allergic reaction to Exparel or any of its ingredients, you shouldn’t take Exparel. Ask your doctor what other medications are better options for you. And if you’re not sure about your medication allergies, talk with your doctor.
  • Pregnancy. It’s not known whether Exparel is safe to use in pregnancy. For more information, see the “Exparel and pregnancy” section above.
  • Breastfeeding. It isn’t known whether Exparel is safe to use while breastfeeding. For more information, see the “Exparel and breastfeeding” section above.

Note: For more information about the potential negative effects of Exparel, see the “Exparel side effects” section above.

The following information is provided for clinicians and other healthcare professionals.

Indications

Exparel is indicated for use as postsurgical:

  • local analgesia, in adults and children ages 6 years and older
  • interscalene brachial plexus nerve block, in adults

Note: It is not known whether Exparel is safe or effective for use as a nerve block in areas of the body other than the brachial plexus.

Administration

Exparel should be administered as a single dose. The drug should not be administered with other local anesthetics that do not contain bupivacaine.

Exparel can be given diluted or undiluted. It can be diluted with either normal saline (0.9%) or lactated Ringer’s solution. To maintain the integrity of its liposomal particles, Exparel should be administered with a 25-gauge or other large-bore needle.

Exparel is administered during surgery.

Mechanism of action

Exparel is a local anesthetic. It works by blocking the conduction of nerve impulses and slowing the propagation of pain stimuli to the brain and spinal cord.

Pharmacokinetics and metabolism

Absorption and duration of action of bupivacaine is dependent on dose and route and area of administration. Bupivacaine that is released from Exparel is absorbed systemically.

In clinical studies, the half-life of Exparel varied from 24 to 34 hours in people who received it for post-surgical analgesia. It varied by an average of 11 hours in people who received it for brachial plexus nerve block.

Contraindications

Exparel is contraindicated in obstetrical paracervical block anesthesia.

Storage

Exparel should be stored in the refrigerator, between 36°F and 46°F (2°C and 8°C). If stored at room temperature, Exparel is stable for only 30 days. However, Exparel should not be re-refrigerated after being kept at room temperature.

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.