Authors' objectives: More than 70 million surgical procedures are performed annually in the United States. Less than half of patients who have surgery report adequate postoperative pain relief. Increasing awareness of issues on the safety of opioids has prompted a focus on best practices in multimodal analgesic regimens. For postoperative use, traditional local anesthetics are limited by their short duration of action. Description of Technology: Exparel is a liposome injection of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia. Liposome preparations increase the duration of action of local anesthetics by delaying the duration of release of the anesthetic compared with administration of traditional preparations of bupivacaine, resulting in a well-controlled, slow release of drug to the local area. Exparel uses DepoFoam technology, a drug delivery system that permits reduced dosing frequency without altering the molecular structure of the delivered drug. A multivesicular liposome is a microscopic structure composed of phospholipid bilayers (lipid molecules with hydrophilic heads and hydrophobic tails) surrounding aqueous materials. Unlike unilamellar liposomes that have a single lipid bilayer, the lipid bilayers of multivesicular liposomes are tightly packed and nonconcentric, resembling a honeycomb. Numerous internal aqueous chambers contain the encapsulated drug. As drug is released, the vesicles rearrange themselves in a process of internal fusion and division. This complex structure leads to increased stability, easier delivery to a specific target, lower plasma levels, and a longer duration of release of the drug from the liposome. Bupivacaine is ideal for this purpose because of its history of wide use and slower kinetics. Local analgesia may be sustained for up to 72 hours. Patient Population: Exparel is indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia. This health technology assessment focuses on liposomal bupivacaine for treatment of postoperative pain in abdominal surgeries. A companion Hayes Directory health technology assessment will evaluate bupivacaine liposome for postoperative pain in joint arthroplasty. Clinical Alternatives: Alternatives to liposomal bupivacaine for treatment of postoperative pain in abdominal surgeries include peripheral and neuraxial blocks, acetaminophen, gabapentinoids, local anesthetics, glucocorticoids, nonsteroidal anti-inflammatory drugs, opioids, and ketamine.

Project Status: Completed

Year Published: 2016

URL for published report: The report may be purchased from: http://www.hayesinc.com/hayes/crd/?crd=16556

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218

Contact Name: saleinfo@hayesinc.com

Contact Email: saleinfo@hayesinc.com

Copyright: 2014 Winifred S. Hayes, Inc