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Side Effects of Exparel

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Side Effects of Exparel

Exparel can be referred to as liposomal marking and is a safe medication for local

anaesthetic. It can last for 72 hours, translating to a difference of 9-fold. This drug has provided

prolonged and successful analgesia after wound infiltration during several surgical procedures.

Therefore, exparel is a medication helping to control and regulate after-surgery pain, enhancing

better recovery. During the surgical procedure, the health practitioner places exparel into an

operated area since it consists of formulated bupivacaine that is designed to release in the body

for a prolonged time to ease the pain. Exparel functions over time, one may need a supplement of

other doses, and it has been proven to aid patients in utilizing fewer opioids in their recovery

process. Whereas it is a non-opioid analgesic without any opioid addiction, exparel is the best

non-opioid drug used after surgery given that it has side effects that come with it as numbness

and allergic reaction are among the side effects

Bupivacaine usage, confined within regional anaesthesia, has local side effects: pain in

the injection site. According to Aggarwal (2018), the drug sometimes penetrates the

bloodstream, causing systemic effects. The systemic effects are known as last or Local

Anesthetic Systemic Toxicity, a rare life-threatening impediment due to intravenous injections or

intra-arterial leading to regional anaesthesia drug absorption. There are numerous estimate

reports of last alongside local anaesthetics. Local exparel infiltration results in substantial plasm

levels of exparel persisting for 96 hours, and the levels cannot be correlated to local efficacy but

causes last effects in the body.

Health practitioners recommend a dosage of 3.8mg/kg as the least amount of

bupivacaine. This increases adverse effects, which include last. Once exparel has been injected

into the bloodstream, it can cause cardio and neuro effects due to sodium channel abundance in
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the injected sites. This affects the body's normal physiology and brings symptoms like

bradycardia or seizures. Liposome bupivacaine interacts with other anaesthetics locally, that is,

lidocaine, mepivacaine, bupivacaine HCI, and ropivacaine resulting in extensive displacement

and free bupivacaine released from liposomes (Discepola et al., 2020). Manufacturers of this

drug warn against administering overdoses, and the injection must happen within twenty minutes

after the administration of lidocaine.

Exparel causes serious or mild side effects. One should visit the doctor in case of

prolonged and possible side effects. Mild side effects of exparel include; constipation, dizziness,

itchiness, neck or back pain, tiredness, anxiety, sleeping troubles, altered tasting ability, muscle

twitching, fever, vomiting and nausea (Buckenmaier, 2017). These side effects may disappear

after a few days or weeks. If they become severe, one can seek further medical intervention from

the doctor.

Further, serious side effects of exparel are not common but sometimes occur. Again,

seeking a doctor's attention is advisable for serious side effects. These serious side effects

include; anemia (low levels of red blood cells in the body) which brings forth weakness,

tiredness, and pale skin. Swelling in the legs or arms is manifested through; shiny or stretched

skin, skin puffiness on the arms, hands, feet, or legs, and dimpled skin if pressed for some

seconds—blood pressure (BP) changes, which can be either too low or high. Symptoms brought

about by this BP include chest pain, sweating, vision problems, and tiredness. A patient may

experience cartilage loss in the joints and abnormal heart rhythm, resulting in irregular heartbeat

and breathing shortness. Urinary retention and methemoglobinemia are other serious effects.

Methemoglobinemia causes skin discoloration, lightheadedness, and seizures. Exparel also

causes allergic reactions, numbness, and falling.

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Allergic Reaction

Some people develop an allergic reaction after injecting or taking Exparel. But no exact

number of people might react to this drug. Some symptoms of a mild allergic reaction include;

skin rash, itchiness, and flushing-described as redness and warmth in the skin. A severe allergic

reaction can be rare, but its symptoms include; under skin swelling-eyelids, hands, feet, lips,

tongue, throat, and mouth swelling.

Numbness

Exparel has an active drug, bupivacaine, used to inject numbness in some parts of the

body. It is normal for a person to feel numb in the injected area as a doctor assures the patient of

normalcy after some time. However, this numbness can spread to other areas of the body where a

patient did not receive exparel, and the condition threatens, leading to emergency and urgent

medical attention from the health practitioners.

Falling

In the clinical studies, falls were the most common side effect in people who use Exparel

as a nerve block. These nerve blocks can be injected into specific body parts to stop nerves from

sending pain signals. These studies claimed that falls occur in 2.4% to 2.7% of people who were

injected with Exparel as a placebo was given to 0.3% of people, which is a treatment without an

active drug. People who receive Exparel as a local analgesic did not experience falls. A doctor

determines whether a fall pertains to receiving exparel or not, and they recommend how to

manage falls. Falls are caused by dizziness, weakness, muscle twitching, numbness, and low

blood pressure.
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Linkage to Opioids Addiction

Exparel is not addictive and is not an opioid (Pacira Pharmaceuticals Inc, 2018). Exparel

regulates pain by releasing medication numbing directly and slowly in the body part where

surgery was performed; therefore, exparel is a non-opioid analgesic. Exparel provides effective

and safe non-opioid pain treatment and management options when a long-acting analgesic nerve

block is medically and clinically appropriate. As a result, admixing exparel with local

anaesthetics is prohibited. The exparel administration follows lidocaine administration after 20

minutes delay. Opioid use in anaesthetic operations is discouraged due to adverse effects that

cause on patients. Exparel and opioids are not linked; therefore, the drug does not cause opioid

addiction. Despite this, opioid drugs are effective painkillers and much addictive, but exparel

eliminates the narcotics need following the surgical procedure. Therefore, exparel is an opioid

alternative for surgery patients.

Briefly, it is estimated that 10 million patients receive non-opioid exparel. The exparel

functions locally at the surgery site, using pMVL or Proprietary multivesicular liposome

technology, encapsulating bupivacaine in multivesicular liposome suspension. After the

administration of the injection, bupivacaine can be released over time. The versatility of

administration and pMVL enables infiltration in the surgical site producing local analgesia,

which produces regional analgesia in a fascial plane as a regional nerve block or interscalene

plexus branchial. Despite being non-opioid, Exparel has side effects ranging from mild to serious

side effects. These side effects include; dizziness, nausea, back pain, swelling in the feet and

hands, constipation, allergic reactions, anxiety, trouble sleeping, altered ability to taste the

flavour, and fever.

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References

Aggarwal, N. (2018). Local anaesthetics systemic toxicity association with exparel (bupivacaine

liposome)-a pharmacovigilance evaluation. Expert opinion on drug safety, 17(6), 581-

587.

Buckenmaier, C. C. (2017). Potential Side Effect of Inadvertent Intravascular Administration of

Liposomal Bupivacaine. Henry M. Jackson Foundation.

Discepola, P., Bouhara, M., Kwon, M., Siddiqui, B. A., Whitwell, T. A., Sanghvi, S. Y., ... &

Eloy, J. D. (2020). Exparel®(Long-acting liposomal bupivacaine) use for popliteal nerve

block in postoperative pain control after ankle fracture fixation. Pain Research and

Management, 2020.

Pacira Pharmaceuticals Inc. (2018, February 15). EXPAREL® (bupivacaine liposome injectable

suspension). U.S. Food and Drug

Administration. https://www.fda.gov/media/111001/download