What is Exparel?

It is rare that I find something new in plastic surgery that makes me say “Wow!” When I heard about FDA approval of this new medication I truly hoped that it would work and wasn’t just hype.

I contacted the company that distributes the drug to get more information, met with the representatives from the company, and was excited to hear when they finally started distributing it.

What is it? Exparel is a long-lasting pain control injection. Marcaine (or bupivacaine) is a local anesthetic which is similar but different in certain ways to the lidocaine, novocaine, and other injectable anesthetics used to numb areas is already a well known local anesthetic. Typically this type of local anesthetic is injected into an area and numbs the area for 4-6 hours. I find that if you inject it into an area that you are operating on, the area stays numb for several hours, thus helping to control pain for that immediate post-procedure time period.

Exparel is different. This is a long-lasting version of bupivacaine. Basically, the bupivacaine is suspended in a time-release liposomal carrier. This allows the Exparel to be injected directly into a spot that is expected to hurt and the liposome slowly releases the bupivacaine for approximately 3 days.

This is a game changer. I have been using this on tummy tucks (abdominoplasty) in my New Jersey plastic surgery practice for several months now. I do several tummy tucks each week and have seen a dramatic decrease in the amount of pain experienced by most patients. While I used to use pain pumps to deliver bupivacaine the pain pump just drips the medication in the general area and it has to be absorbed by the target site. This injection puts the Exparel exactly where I want it. The amount of decreased pain is astounding. My receptionists, my nurses, and my medical assistants have all remarked about how much quicker these patients are recovering. They walk faster and better. They take less narcotic medication. Overall, I find it to be a wonder-drug.

The downsides of this product are few. It is very costly at about $300 a vial. Is this worth improved pain control? I certainly think so. I am trying to get the hospital to allow surgeons to use it however the pharmacy committees and medication approval committees are reluctant to approve an expensive medication such as this and I am fighting an uphill battle. This is one more reason it is nice to have my own AAAASF plastic surgical suite in my Cherry Hill practice as I don’t need to get permission from bean counters, I just do what is right for the patient.

I am excited about this medication and potential uses in other procedures such as breast reductions, breast lifts, and even straight forward breast augmentation. Stay tuned….

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