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A U G U S T 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
soft tissue procedures that lead to an improvement in other clinical
outcomes examined (ambulation, time to flatus and others, for exam-
ple). In our evaluations, which looked at Exparel compared to PCAs
and epidurals, we saw no clinically significant differences in pain
scores — a nod to the efficacy of Exparel, which seems to rival con-
siderably potent treatment modalities — but the decrease in opioid
consumption gave way to markedly better clinical outcomes.
Regardless, if this article decided that the battle between Exparel
and standard bupivacaine would be won or lost based solely on pain
scores, then it should have factored in the results of 2 important, peer-
reviewed studies presenting Level I evidence demonstrating the statis-
tically significant decrease in pain scores associated with Exparel:
• A double-blind, randomized, active-controlled prospective study
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found that colorectal surgery patients in the Exparel arm had statisti-
cally superior post-operative NRS (numeric rating scale) pain scores
and significantly less opioid use than patients in the standard bupiva-
caine arm.
• A pooled analysis of efficacy and safety data from 9 double-blind,
placebo- or active-controlled multimodal analgesia studies comparing
liposome bupivacaine to standard bupivacaine across 5 surgical mod-
els
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found that Exparel in a multimodal setting was associated with
statistically significant and clinically meaningful lower cumulative
pain scores at 72 hours, delayed and less consumption of opioids, and
fewer ORAEs (opioid-related adverse events) than bupivacaine HCl.
While a deep data dive serves a critical function when making evi-
dence-based decisions, it is most meaningful when viewed through
the lens of clinical experience and real-world outcomes. I sincerely
hope your readers will take an independent view of all the available
data on Exparel, weigh it against their own clinical experience, and
that of their peers and peer institutions, and formulate an evidence-
