Hemorrhoidectomy-Inf..

One Dose Provides Pain Control
With Decreased Opioid Use*
EXPAREL is a local analgesic that utilizes bupivacaine
• Dose EXPAREL based on the surgical site and the volume required to cover the area
• Infiltrate using the same technique surgeons already use to infiltrate local anesthetics
• EXPAREL is available as 1.3%, 20 mL single-use vials
•E
XPAREL is supplied in a ready-to-use aqueous
suspension, or it can be diluted with normal saline or
lactated Ringer’s solution to accommodate administration
into a larger surgical site
• EXPAREL can be used with needles as narrow as 25 gauge
*The clinical benefit of the attendant decrease in opioid consumption was not demonstrated.
Some physicochemical incompatibilities exist between EXPAREL and certain other drugs.
Direct contact of EXPAREL with these drugs results in a rapid increase in free (unencapsulated)
bupivacaine, altering EXPAREL characteristics and potentially affecting the safety and efficacy
of EXPAREL. Therefore, admixing EXPAREL with other drugs prior to administration is not
recommended. Please refer to accompanying Prescribing Information for a more detailed
description of the administration precautions.
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.
Please refer to accompanying full Prescribing Information.
www.EXPAREL.com
© 2015 Pacira Pharmaceuticals, Inc.
Parsippany, NJ 07054
PP-EX-US-0581
01/15
Please see additional administration precautions and Important Safety Information on the opposite side.
EXPAREL is indicated for administration into the surgical site to produce postsurgical analgesia.
Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved. www.nucleusinc.com
Posterior
improving postsurgical analgesia
covers the whole surgical site is critical to
•E
nsuring a meticulous technique that
5 mL
5 mL anteriorly
10 mL on the right side; 5 mL posteriorly and
each side of the anus, 10 mL on the left side and
• EXPAREL was injected in a fanlike fashion on
5 mL
5 mL
5m
mL
L
5 mL
Right
until the aspiration was negative
moved and placed in a different location
Left
5 mL
— If the aspiration drew blood, the needle was
injection had occurred
technique to verify that no accidental intravascular
using a standard anal infiltrative moving-needle
Anterior
•E
XPAREL was injected slowly into soft tissue
Technique Can Impact
Postsurgical Analgesia
indicated in the figure
external sphincter) with the volumes of EXPAREL
by infiltrating the perianal tissues (just outside the
•A
standard anal block procedure was performed
technique
external hemorrhoids using the Milligan-Morgan
hemorrhoidectomy for internal or internal/
•S
urgery was a 2- or 3-column excisional
EXPAREL Was Infiltrated Using
a Deep-Tissue Technique
Infiltration Technique Used
During Hemorrhoidectomy Procedure
One Dose Provides Pain Control
With Decreased Opioid Use*
EXPAREL is a local analgesic that utilizes bupivacaine
• Dose EXPAREL based on the surgical site and the volume required to cover the area
• Infiltrate using the same technique surgeons already use to infiltrate local anesthetics
• EXPAREL is available as 1.3%, 20 mL single-use vials
•E
XPAREL is supplied in a ready-to-use aqueous
suspension, or it can be diluted with normal saline or
lactated Ringer’s solution to accommodate administration
into a larger surgical site
• EXPAREL can be used with needles as narrow as 25 gauge
*The clinical benefit of the attendant decrease in opioid consumption was not demonstrated.
Some physicochemical incompatibilities exist between EXPAREL and certain other drugs.
Direct contact of EXPAREL with these drugs results in a rapid increase in free (unencapsulated)
bupivacaine, altering EXPAREL characteristics and potentially affecting the safety and efficacy
of EXPAREL. Therefore, admixing EXPAREL with other drugs prior to administration is not
recommended. Please refer to accompanying Prescribing Information for a more detailed
description of the administration precautions.
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.
Please refer to accompanying full Prescribing Information.
www.EXPAREL.com
© 2015 Pacira Pharmaceuticals, Inc.
Parsippany, NJ 07054
PP-EX-US-0581
01/15
Please see additional administration precautions and Important Safety Information on the opposite side.
EXPAREL is indicated for administration into the surgical site to produce postsurgical analgesia.
Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved. www.nucleusinc.com
Posterior
improving postsurgical analgesia
covers the whole surgical site is critical to
•E
nsuring a meticulous technique that
5 mL
5 mL anteriorly
10 mL on the right side; 5 mL posteriorly and
each side of the anus, 10 mL on the left side and
• EXPAREL was injected in a fanlike fashion on
until the aspiration was negative
5 mL
5m
mL
L
Right
5 mL
moved and placed in a different location
— If the aspiration drew blood, the needle was
5 mL
5 mL
injection had occurred
technique to verify that no accidental intravascular
using a standard anal infiltrative moving-needle
•E
XPAREL was injected slowly into soft tissue
Technique Can Impact
Postsurgical Analgesia
indicated in the figure
external sphincter) with the volumes of EXPAREL
by infiltrating the perianal tissues (just outside the
•A
standard anal block procedure was performed
technique
external hemorrhoids using the Milligan-Morgan
hemorrhoidectomy for internal or internal/
•S
urgery was a 2- or 3-column excisional
EXPAREL Was Infiltrated Using
a Deep-Tissue Technique
Infiltration Technique Used
During Hemorrhoidectomy Procedure
Anterior
Left