Bupivacaine

Surgical-context view of the EXPAREL liposomal bupivacaine UK SPC (single-dose post-operative pain management), for adults and children aged 6 years or older; dose based on surgical site size, volume required to cover the area and individual patient factors. Field block examples: bunionectomy total 106 mg (8 mL, with 7 mL around the osteotomy and 1 mL subcutaneous); haemorrhoidectomy total 266 mg (20 mL) diluted with 10 mL saline to 30 mL, in six 5 mL aliquots. Peripheral nerve block examples: femoral nerve block for total knee arthroplasty 266 mg (20 mL); brachial plexus block for total shoulder arthroplasty or rotator cuff repair 133 mg (10 mL) diluted to 20 mL. Efficacy and safety not established in major abdominal, vascular and thoracic surgery. May be given 'as is' or expanded with 0.9% saline to 0.89 mg/mL (1:14 by volume). Administer with a 25 gauge or larger needle; inject slowly (1-2 mL per injection) with frequent aspiration. Liposomal preparation — NOT interchangeable with other bupivacaine formulations; if admixed with bupivacaine HCl the total must not exceed 400 mg equivalents of bupivacaine HCl in adults and the HCl:liposomal ratio must not exceed 1:2. Administer only where trained personnel and resuscitation equipment are available. Elderly: no dose adjustment required. Hepatic impairment: no adjustment in mild/moderate; insufficient data in severe.

Liposomal bupivacaine (EXPAREL) in paediatric patients aged 6 years and older, as a single-dose field block for somatic post-operative pain from small- to medium-sized surgical wounds. Not established as a field block in children 1 to <6 years, nor as a nerve block in children 1 to <18 years. Must not be used in children under 1 year. Verify dose against a children's formulary.