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The Role of Exparel Plus Meloxicam for Postoperative Pain Management

  • Other Pain (AD Kaye, N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Acute postoperative pain reduction is a major target against the opioid crisis. While opioids have traditionally been the mainstay for postoperative analgesia, current practice has focused on a multimodal approach to pain control, including ultrasound-guided blocks with longer acting local anesthetic agents.

Recent Findings

Non-steroidal anti-inflammatory drugs (NSAIDs), such as meloxicam, are an important class of medications utilized to manage pain in the perioperative period. An additional treatment used in perioperative or postoperative pain relief is Exparel, a bupivacaine (sodium channel blocker) liposomal injectable suspension with a 3–4-day duration of action. The long-acting mechanism and formulation of Exparel consistently has demonstrated decreased opioid use and pain scores in patients undergoing many different surgical procedures. A concern is that pH negatively alters the efficacy of bupivacaine, as in cases of inflamed tissue and acidic fluid pH. For this reason, a combination medication with both meloxicam and bupivacaine has been developed, which normalizes pH and has anti-inflammatory and anti-pain conduction properties. Clinical studies demonstrate that this combination agent can be extremely beneficial in treating postoperative pain.

Summary

This manuscript summarizes the newest developments with regard to liposomal bupivacaine and the non-steroidal meloxicam, their roles in effective treatment of postoperative pain, contraindications, special considerations of using these medications, and future considerations. HTX-011 pairs up a new extended-release formulation of the local anesthetic bupivacaine with meloxicam, a well-established non-steroidal anti-inflammatory drug (NSAID).

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Authors and Affiliations

  1. Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA

    Alan David Kaye

  2. University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Matthew B. Novitch

  3. Medical College of Wisconsin, Milwaukee, WI, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA

    Sam F. Carlson, Mitchell C. Fuller, Shane W. White, Alexander R. Haroldson & Jennifer A. Kaiser

  4. Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA

    Mohamed A. Elkersh & Andrew J. Brunk

  5. LSU School of Medicine, New Orleans, and Research Associate, Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA

    George M. Jeha

  6. Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Elyse M. Cornett

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  1. Alan David Kaye
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Correspondence to Elyse M. Cornett.

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Matthew Notitch, Sam Carlson, Mitchell Fuller, Shane White, Mohamed Elkersh, Alexander Haroldson, Jennifer Kaiser, Andrew Brunk, George Jeha, and Elyse Cornett declare no conflict of interest.

Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript.

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Kaye, A.D., Novitch, M.B., Carlson, S.F. et al. The Role of Exparel Plus Meloxicam for Postoperative Pain Management. Curr Pain Headache Rep 24, 6 (2020). https://doi.org/10.1007/s11916-020-0837-2

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