Pain Management in the Surgical Setting

Are You Lighting the Fuse of Opioid Addiction?

Dependency can begin within 3 DAYS of opioid use.1

ON-Q* is indicated to significantly reduce opioids and provide better pain relief than opioids alone.

Liposomal bupivacaine (LB) claims to be a viable option. However:

  • Recent studies and clinical reviews of the data have concluded that LB does not appear to offer additional benefits compared with other local anesthetics2,3
  • Clinical trial data have shown that LB reduces pain for only up to a maximum of 24 hours.2-5 ON-Q* provides pain control for days, not just hours
  • LB’s “one-size-fits-all” approach cannot be titrated or turned off,6 and leaves the potential risk of local anesthetic toxicity if used for breakthrough pain3,7,8

See below for how LB compares with long-lasting ON-Q.*


1. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use – United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265-269.

2. VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives. Bupivacaine liposome injectable suspension (Exparel®) update. Published March 2016. Accessed January 25, 2018.

3. Noviasky J, Pierce DP, Whalen K, Guharoy R, Hildreth K. Bupivacaine liposomal versus bupivacaine: comparative review. Hosp Pharm. 2014:49(6):539-543.

4. Golf M, Daniels SE, Onel E. A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. 2011;28(9):776-788.

5. Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54(12):1552-1559.

6. Ilfeld BM. Liposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain. Expert Opin Pharmacother. 2013;14(17):2421-2431.

7. Aggarwal N. Local anesthetics systemic toxicity association with exparel (bupivacaine liposome) – a pharmacovigilance evaluation [published online ahead of print June 5, 2017]. Expert Opin Drug 2017:1-7. doi:10.1080/14740338.2017.1334304.

8. EXPAREL (bupivacaine liposome). Prescribing Information. San Diego, CA: Pacira Pharmaceuticals, Inc; 2018.

9. Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth. 2008;101(6):841-847.

10. Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty. 2018;33(1):90-96.

11. Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg. 2015;120(5):1114-1129.

12. Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder: a double‐blind, randomized controlled trial. J Bone Joint Surg [Br]. 2006;88(9):1173‐1177.

13. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 suppl):S105-S120.

14. Bingham AE, Fu R, Horn JL, Abrahams MS. Continuous peripheral nerve block compared with single‐injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2012;37(6):583‐594.

15. Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract. 2012;2012:560879.

16. Halyard data on file.

17. Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203(6):914-932.

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