5 things to know about Exparel – A New, Awesome Way to Reduce Tummy Tuck Pain after Surgery

Tummy tucks hurt. We are trying to control or prevent pain using different techniques.  Exparel is a relatively new medication on the market which numbs the area.  Numb = less pain.  Less pain = happier recovery, happier patient, less pain pills taken.

What do you need to know?

Exparel reduces the need for opioids while providing long lasting post surgical pain control from a single dose.  As they like to state, “EXPAREL starts controlling postsurgical pain before you wake up from surgery—your doctor injects it directly into the site of your surgery during the procedure.”

1. How does it work?
   1. It is injected by the surgeon (me) during the surgery (you are asleep).
   2. It is a unique drug delivery system, where bupivacaine (a long acting local anesthetic like lidocaine) is wrapped in “depofoam”
   3. The Depofoam encapsulates the local anesthetic with a liposomal drug delivery technology
   4. This releases the anesthetic slowly over time as the lipid membranes reorganize.  It lasts for about 72 hours.
2. Significant long lasting pain control.
   1. Studies show 30% reduction in cumulative pain scores vs. placebo
   2. Significant reduction in pain intensity vs placebo for the first 24 hours
   3. By 24 hours, 88% of placebo were rescuing with opioids, vs. 64% in the exparel group
3. Significant decrease in opioid consumption.
   1. Studies show 45% reduction in overall opioid consumption
   2. 28% of exparel group did not require any rescue medication through the 72 hour study
4. It is safe.
   1. Safety evaluated in 10 clinical trials.
   2. More than 2.5 million patients have received since 2012
5. It is a single dose administration. 
   1. I, the surgeon, mix it with saline to allow me to spread the medication over the affected area.  (For a tummy tuck this is along the muscle and along the incision).
   2. It does not spread as much as traditional local anesthetics do, so placement is key.

What have I found?

I have used this for a while now.  I find my patients have significantly reduced or no pain for the first day after surgery.  Their overall pain medication use tends to be less, and they tend to be off all pain medication faster.  So what was found in the studies above is supported by what I have seen in practice.

I like using different ways to treat pain after surgery.  Narcotics (think Vicodin, Percoset) all have side effects- constipation, nausea, feeling out of it- and they are addictive.  It is thought many addictions are started from people getting opioids during surgery.

Exparel isn’t cheap.  But I think it is worth the cost.  There are many studies showing if you never let the pain response start (by blocking the pain receptors during surgery with the injection of a local anesthetic), that the level of pain and need for pain medication decreases.

When it comes to pain, prevention is the key.