Systematic Review of Liposomal Bupivacaine (Exparel) for Postoperative Analgesia

Krishna S. Vyas, Sibi Rajendran, Shane D. Morrison, Afaaf Shakir, Samir Mardini, Valerie Lemaine, Maurice Y. Nahabedian, Stephen B. Baker, Brian D. Rinker, Henry C. Vasconez

Research output: Contribution to journalReview articlepeer-review

96 Scopus citations


Background: Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system. The effectiveness of liposomal bupivacaine has not been systematically analyzed relative to conventional treatments in plastic surgery. Methods: A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through October of 2015 with search terms related to liposomal bupivacaine and filtered for relevance to postoperative pain control in plastic surgery. Data on techniques, outcomes, complications, and patient satisfaction were collected. Results: A total of eight articles were selected and reviewed from 160 identified. Articles covered a variety of techniques using liposomal bupivacaine for postoperative pain management. Four hundred five patients underwent procedures (including breast reconstruction, augmentation mammaplasty, abdominal wall reconstruction, mastectomy, and abdominoplasty) where pain was managed with liposomal bupivacaine and compared with those receiving traditional pain management. Liposomal bupivacaine use showed adequate safety and tolerability and, compared to traditional protocols, was equivalent or more effective in postoperative pain management. Conclusion: Liposomal bupivacaine is a safe method for postoperative pain control in the setting of plastic surgery and may represent an alternative to more invasive pain management systems such as patient-controlled analgesia, epidurals, peripheral nerve catheters, or intravenous narcotics.

Original languageEnglish
Pages (from-to)748e-756e
JournalPlastic and Reconstructive Surgery
Issue number4
StatePublished - Oct 1 2016

Bibliographical note

Publisher Copyright:
Copyright © 2016 by the American Society of Plastic Surgeons.

ASJC Scopus subject areas

  • Surgery


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