To compare pain experience and opioid use after distal radius fracture repair surgery performed with perioperative infiltration of the local anesthesia bupivacaine hydrochloride (Marcaine; Pfizer, New York, NY) or bupivacaine liposome (Exparel; Pacira, Parsippany, NJ).
We conducted a prospective comparison of consecutive patients scheduled to undergo distal radius fracture repair surgery. Patients were randomized to either Marcaine or Exparel. Patients in the Marcaine group received 20 mL 0.5% bupivacaine without epinephrine into the incision and surgical site before incision. Patients in the Exparel group first received 10 mL 0.5% Marcaine with no epinephrine into the incision and surgical site before incision; then, upon completion of the surgery and wound closure, they also received 10 mL Exparel into the same site that had been preinjected with Marcaine. All operations were performed with the same surgical technique. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded from postoperative days 0 to 5.
On the day of surgery, patients in the Exparel group reported significantly lower pain levels (3.9 vs 5.8) and consumed significantly fewer prescribed opioid pills (1.2 vs 2.0) compared with patients in the Marcaine group. However, there were no other significant differences between the Exparel and Marcaine groups on any subsequent days or in the total number of pills consumed at the end of the study period (7.5 vs 8.9 pills, respectively). No major adverse reactions were noted in either group.
Exparel use was found to result in decreased pain and opioid consumption only on the day of surgery and not thereafter.
Type of study/level of evidence
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- Bupivacaine liposome injectable suspension: a new approach to postsurgical pain.Drugs Today. 2013; 49: 475-482
- Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial.Dis Colon Rectum. 2011; 54: 1552-1559
- A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty.Knee. 2012; 19: 530-536
- A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy.Adv Ther. 2011; 28: 776-788
- Potential utility of liposome bupivacaine in orthopedic surgery.Am J Orthop. 2015; 44: 111-117
- Pharmacology of drugs formulated with DepoFoam™: a sustained release drug delivery system for parenteral administration using multivesicular liposome technology.Clin Pharmacokinet. 2006; 45: 1153-1176
- Evaluation of DepoFoam® bupivacaine for the treatment of postsurgical pain.Pain Manag. 2011; 1: 539-547
- Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain.Pharmacotherapy. 2012; 32: 19S-26S
- Pharmacokinetic profile of liposome bupivacaine injection following a single administration at the surgical site.Clin Drug Investig. 2013; 33: 109-115
- Safety and side effect profile of liposome bupivacaine (Exparel) in peripheral nerve blocks.Reg Anesth Pain Med. 2015; 40: 572-582
- Bupivacaine liposome injectable suspension compared with bupivacaine HCl for the reduction of opioid burden in the postsurgical setting.Curr Med Res Opin. 2012; 28: 1609-1615
- Liposome bupivacaine for improvement in economic outcomes and opioid burden in GI surgery: IMPROVE Study pooled analysis.J Pain Res. 2014; 7: 359-366
- The AAHKS Clinical Research Award: liposomal bupivacaine and periarticular injection are not superior to single-shot intra-articular injection for pain control in total knee arthroplasty.J Arthroplasty. 2016; 31: 22-25
- Surgical approaches to the distal radius.Hand (N Y). 2011; 6: 8-17
- A prospective evaluation of opioid utilization after upper-extremity surgical procedures: identifying consumption patterns and determining prescribing guidelines.J Bone Joint Surg Am. 2016; 98: e89
- Treatment strategies of distal radius fractures.Hand Clin. 2012; 28: 177-184
- Pain management strategies in hand surgery.Orthop Clin North Am. 2015; 46 (xi): 399-408
- Postoperative pain treatment for ambulatory surgery.Best Pract Res Clin Anaesthesiol. 2007; 21: 129-148
- Postoperative pain in ambulatory surgery.Anesth Analg. 1997; 85: 808-816
- Survey of postoperative analgesia following ambulatory surgery.Acta Anaesthesiol Scand. 1997; 41: 1017-1022
- Opioid complications and side effects.Pain Physician. 2008; 11: S105-S120
- Dependence and addiction during chronic opioid therapy.J Med Toxicol. 2012; 8: 393-399
- Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.Dermatol Surg. 1996; 22: 921-927
- Safety of peak serum lidocaine concentration after Mohs micrographic surgery: a prospective cohort study.J Am Acad Dermatol. 2010; 63: 87-92
- Does liposomal bupivacaine (Exparel) significantly reduce postoperative pain/numbness in symptomatic teeth with a diagnosis of necrosis? A prospective, randomized, double-blind trial.J Endod. 2016; 42: 1301-1306
- Bupivacaine versus liposomal bupivacaine for postoperative pain control after augmentation mammaplasty: a prospective, randomized, double-blind trial.Aesthet Surg J. 2016; 36: NP47-NP52
- Liposomal bupivacaine incisional injection in single-level lumbar spine surgery.Spine J. 2016; 16: 1305-1308
- The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients.J Arthroplasty. 2015; 30: 325-329
- Liposomal bupivacaine for pain control after anterior cruciate ligament reconstruction: a prospective, double-blinded, randomized, positive-controlled trial.Am J Sports Med. 2016; 44: 1680-1686
- Wide awake trigger finger release surgery: prospective comparison of lidocaine, Marcaine, and Exparel.Hand (N Y). 2016; 11: 177-183
Lewis AN. Liposomal bupivacaine (Exparel). Pharmacy Times. http://www.pharmacytimes.com/publications/health-system-edition/2013/january2013/liposomal-bupivacaine-exparel. Accessed January 2, 2017.
- Systematic review of liposomal bupivacaine (Exparel) for postoperative analgesia.Plast Reconstr Surg. 2016; 138: 748e-756e
- The efficacy and safety of DepoFoam bupivacaine in patients undergoing bilateral, cosmetic, submuscular augmentation mammaplasty: a randomized, double-blind, active-control study.Aesthet Surg J. 2012; 32: 69-76
Published online: September 29, 2017
Accepted: August 22, 2017
Received: January 6, 2017
The study was supported by an unrestricted educational grant from Pacira Pharmaceuticals Inc.
© 2017 by the American Society for Surgery of the Hand. All rights reserved.