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EP115 Trends in exparel use for total hip and knee arthroplasty
  1. Ottokar Stundner1,
  2. Haoyan Zhong2,
  3. Alex Illescas2,
  4. Crispiana Cozowicz3,
  5. Jashvant Poeran4,
  6. Jiabin Liu2 and
  7. Stavros G Memtsoudis2
  1. 1Department of Anesthesiology and Intensive Care, Innsbruck Medical University, Innsbruck, Austria
  2. 2Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, USA
  3. 3Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  4. 4Institute for Healthcare Delivery Science, Department of Population Health Science and Policy/Department of Orthopedics/Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA


Background and Aims ExparelTM, a liposomal bupivacaine formulation, is a long-acting local anesthetic that can provide pain relief after total hip or knee arthroplasty (THA/TKA) when used for local wound infiltration or peripheral nerve blocks. At the same time, Exparel is a relatively expensive medication, and its use can increase healthcare costs. As population-level trend data remain rare, we aimed to investigate nationwide trends of Exparel use in the United States for THA/TKA.

Methods This study was approved by the institutional review board of the Hospital for Special Surgery (IRB#2012-050). We identified patients from the Premier Healthcare database who underwent elective THA/TKA using a standard set of International Classification of Diseases -ninth/tenth revision codes from 2012 to 2021. We examined the use of Exparel over time at both the patient and hospital levels.

Results Among 103,165 cases, Exparel use increased from 2012 to 2015 (0.36% to 22.8%), and decreased afterward (15.7% in 2021) (table 1). At the hospital level, 599 hospitals (59.7%) ever used Exparel during the study period. In 2013, 30% of hospitals started to initiate Exparel use, and the rate has been decreasing over time (compared to 3.1% hospital initiated Exparel use in 2021). In 2014, hospitals started to terminate Exparel (1.1%); this termination rate increased and peaked in 2019 (9.5%). (figure 1)

Abstract EP115 Figure 1

Exparel use trends on hospital level

Abstract EP115 Table 1

Exparel use trends on patient level

Conclusions The use of Exparel peaked around the year 2014-2015 and has been decreasing afterward. The reason for hospitals stopping Exparel use may be related to recent evidence for its modest efficacy and should be studied further.


  • exparel
  • bupivacaine
  • liposomal
  • total hip arthroplasty
  • total knee arthroplasty
  • trends

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