• John W Barrington, David F Dalury, Roger H Emerson, Richard J Hawkins, Girish P Joshi, and Bernard N Stulberg.
• Texas Center for Joint Replacement, Plano, TX. rogeremerson@texashealth.org.
• Am J. Orthop. 2013 Oct 1;42(10 Suppl):S1-S20.

AbstractPain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay. This article examines the use of bupivacaine liposome injectable suspension (EXPAREL®; Pacira Pharmaceuticals, Inc., San Diego, California), a non-opioid product for pain management. Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief.

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