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When considering the use of EXPAREL, it's important to be aware of specific safety considerations to ensure its appropriate and safe application:

• Contraindications: EXPAREL should not be used for obstetrical paracervical block anesthesia due to potential risks to the fetus.

• Administration Guidelines: Avoid injecting EXPAREL into the spine (epidural or intrathecal), joints (intra-articular), or blood vessels (intravascular). Additionally, do not use it for nerve blocks other than the interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and adductor canal block.

• Patient Populations: EXPAREL is not recommended for patients under 6 years old for infiltration, those younger than 18 years old for nerve blocks, or pregnant women.

• Liver Function: Since bupivacaine, the active ingredient in EXPAREL, is metabolized by the liver, caution is advised when administering it to patients with liver disease.

• Use with Other Local Anesthetics: Do not mix EXPAREL with lidocaine or other non-bupivacaine local anesthetics, as this can cause an immediate release of bupivacaine from EXPAREL. If lidocaine is used, wait at least 20 minutes before administering EXPAREL at the same site.

• Additional Local Anesthetics: Avoid using other local anesthetics within 96 hours after administering EXPAREL to prevent potential toxicity.

• Sensory and Motor Effects: Temporary loss of sensation or muscle movement may occur, varying in degree and duration based on the injection site and dosage. These effects can last up to 5 days.

• Central Nervous System (CNS) Reactions: There have been reports of adverse neurological reactions with the use of local anesthetics, including persistent anesthesia and paresthesia. CNS reactions are characterized by excitation and/or depression.

• Cardiovascular Reactions: Toxic blood concentrations can depress cardiac conductivity and excitability, potentially leading to dysrhythmias, sometimes resulting in death.

• Allergic Reactions: Although rare, allergic-type reactions such as anaphylaxis and angioedema may occur due to hypersensitivity to the local anesthetic or other formulation ingredients.

• Chondrolysis: There have been reports of chondrolysis (mostly in the shoulder joint) following intra-articular infusion of local anesthetics, which is an unapproved use.

• Methemoglobinemia: Cases of methemoglobinemia have been reported with local anesthetic use.

By adhering to these guidelines and precautions, healthcare providers can help ensure the safe and effective use of EXPAREL in managing postsurgical pain.

Exparel is a medication used to manage pain after surgery by numbing specific areas of the body. While it can be effective in reducing discomfort, it's important to be aware of potential side effects that may occur. Common Side Effects:

• Nausea and Vomiting: These are frequently reported after receiving Exparel.
• Constipation: Some individuals may experience difficulty with bowel movements.
• Fever: An elevated body temperature can occur in some cases.
• Headache: Mild to moderate headaches have been noted.
• Dizziness or Drowsiness: Feelings of lightheadedness or sleepiness may be present. Serious Side Effects: Although less common, certain serious side effects require immediate medical attention:
• Allergic Reactions: Signs include hives, swelling of the face or throat, difficulty breathing, and dizziness.
• Heart Rhythm Changes: Symptoms such as a fast or irregular heartbeat, chest pain, or shortness of breath may indicate heart-related issues.
• Methemoglobinemia: This rare blood disorder affects oxygen delivery in the body. Symptoms include pale or blue-colored skin, headache, rapid heartbeat, shortness of breath, and fatigue.
• Neurological Effects: Signs like confusion, restlessness, numbness or tingling around the mouth, blurred vision, or seizures may occur. It's also noteworthy that Exparel can cause temporary loss of sensation or muscle movement in the treated area, which may last up to five days. If you experience any of these side effects, especially the serious ones, contact your healthcare provider immediately. They can provide guidance on managing these effects and determine if any further action is necessary.

When considering Exparel for pain management, it's important to be aware of potential interactions with other medications. Exparel, a local anesthetic, can interact with various drugs, leading to increased side effects or reduced effectiveness.

Local Anesthetics: Avoid using other local anesthetics, such as Lidocaine or Benzocaine, within 96 hours after receiving Exparel. Combining these can enhance side effects and may affect how Exparel works.

Medications That May Cause Methemoglobinemia: Exparel can increase the risk of methemoglobinemia, a condition where the blood carries less oxygen. Using Exparel with certain drugs can heighten this risk. These include:

• Antibiotics like Dapsone and Nitrofurantoin
• Antimalarial drugs such as chloroquine and Primaquine
• Cancer treatments like Cyclophosphamide and Flutamide
• Seizure medications including Phenobarbital and Phenytoin
• Pain relievers like Acetaminophen
• Other drugs such as Metoclopramide and Sulfasalazine

Central Nervous System Depressants: Combining Exparel with medications that depress the central nervous system, like benzodiazepines (e.g., Diazepam, Alprazolam) or certain muscle relaxants, can increase side effects such as dizziness, drowsiness, and confusion. It's advisable to avoid activities requiring alertness, like driving, until you know how these combinations affect you.

Alcohol and Grapefruit Products: While no direct interactions between Exparel and alcohol or grapefruit have been identified, it's best to consult your healthcare provider about consuming these substances around the time of your treatment.

Always inform your healthcare provider about all medications, supplements, and over-the-counter drugs you are taking before receiving Exparel. This ensures safe and effective pain management tailored to your needs.