One vial of EXPAREL cost 150$ (?, or more ). This drug will not sell, there are many other safer and much cheaper alternatives ( lidocaine, ropivacaine, regular bupivacaine). One vial of regular bupivacaine cost 2-3$ ( for 20 cc vial ). Has many restrictions, can not be used with other locals ( like lidocaine ) which is common practice in OBS, plus not approved for nerve blocks ( blocks are new major trend in anesthesia! ). Long release increasing chances of local anesthetic toxicity, or prolong contact with tissue may cause soft tissue, or nerve damage ( that's why not used for nerve blocks ). Basically can be used only for surgical wound infiltration.
Important Safety Information
EXPAREL is contraindicated in obstetrical paracervical block anesthesia. EXPAREL has not been studied for use in patients younger than 18 years of age. Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Other formulations of bupivacaine should not be administered within 96 hours following administration of EXPAREL. Monitoring of cardiovascular and neurological status, as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products. Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. In clinical trials, the most common adverse reactions (incidence ≥10%) following EXPAREL administration were nausea, constipation, and vomiting