Exparel dosage: form, strength, how it’s given (and what to expect)

Want the short answer? Exparel dosage depends on the surgical site, route, and patient factors. Adults typically receive up to 266 mg for local infiltration or 133 mg for certain nerve blocks; kids 6under 17 years are dosed by weight, up to 4 mg/kg (max 266 mg). That's the headline. But if you're deciding whether Exparel is right for you or your child, you probably want more than the headlineyou want the full picture, in plain language.

The goal with Exparel is steady pain relief that helps you need fewer opioids and feel more like yourself after surgery. But it only works well when used correctly. In this guide, we'll walk through Exparel uses, strengths, how it's administered, safety checks, and side effectsso you can weigh the benefits and risks with your care team and feel confident about your recovery plan.

What is Exparel

Quick definition and mechanism

Exparel is a long-acting local anesthetic. Think of it as numbing medicine that's engineered to last longer than standard bupivacaine. Instead of wearing off after several hours, Exparel often provides pain control for days.

Liposomal bupivacaine: how slow-release pain control works

Here's the cool part. Exparel contains bupivacaine trapped inside tiny fat-like spheres called liposomes. These little "time-capsules" release bupivacaine slowly, which stretches the pain relief window. It's like a drip-irrigation system for numbnesssteady, measured, and designed to cover those first few tough days after surgery.

FDA-approved uses and age limits

Exparel has specific approvalsthis matters for safety and expectations.

Postsurgical local infiltration (6 years); adult regional blocks: interscalene, adductor canal, sciatic

Approved uses include:

• Local infiltration into the surgical site for adults and children 6 to <17 years.
• Specific regional nerve blocks in adults only: interscalene brachial plexus block (shoulder), adductor canal block (knee), and sciatic nerve block at the popliteal fossa (lower leg/foot).

Not approved for epidural, intrathecal, intra-articular, or other nerve blocks

Exparel is not for epidurals, spinal (intrathecal) injections, or inside joints. It also isn't approved for every nerve block under the sunjust the ones listed above. Off-label routes can increase risk without clear benefit.

Who might benefit

Procedures commonly using Exparel (e.g., hernia repair, mastectomy, joint surgery, C-section infiltration)

If your surgeon wants you moving sooner and using fewer opioids, Exparel may be part of that plan. It's used after a wide range of surgerieshernia repair, mastectomy or lumpectomy, knee or foot surgery, C-section incision infiltration, and more. Not every case needs it, but for moderate-to-severe post-op pain, it can help smooth the rough edges.

When Exparel may not be a fit (pregnancy, severe liver disease, certain block types)

Your team may steer away from Exparel if you have severe liver disease (bupivacaine is metabolized in the liver), certain heart conditions, or a history of severe reactions to amide-type local anesthetics. It's also not used for obstetrical paracervical blocks and shouldn't be injected into joints or CSF spaces.

Dosage at a glance

Forms and strengths

Exparel comes ready-to-use in single-dose vials:

• 133 mg in 10 mL
• 266 mg in 20 mL

Each vial contains a 1.3% bupivacaine liposome suspension.

Adult dosing by indication

Local infiltration: dose based on site size/volume; do not exceed 266 mg

For adults, the surgical site's size and how much tissue needs coverage guide the volume. The ceiling is 266 mg total. Surgeons often "expand" the volume with saline or lactated Ringer's to spread coveragemore on that in a moment.

Interscalene brachial plexus block: 133 mg (10 mL)

For shoulder procedures, the interscalene block dose is typically 133 mg.

Adductor canal block: 133 mg + 50 mg bupivacaine HCl (total 20 mL)

For knee surgery, many clinicians combine 133 mg Exparel with 50 mg of standard bupivacaine HCl to kick in earlier relief while the liposomes take over for the long haul.

Sciatic block (popliteal fossa): 133 mg (10 mL)

For certain foot and ankle surgeries, 133 mg at the popliteal fossa is common.

Pediatric dosing (6 to <17 years)

4 mg/kg up to 266 mg for local infiltration; nerve blocks not established for <18 years

In kids and teens 6 to under 17 years, the local infiltration dose is weight-based at 4 mg/kg, not to exceed 266 mg. Regional nerve blocks with Exparel haven't been established for patients under 18, so infiltration is the pediatric route used.

Choosing volume and expanding for coverage

When and how to expand with saline/LR; keep 0.89 mg/mL concentration

To cover larger surgical fields, clinicians can dilute Exparel with normal saline or lactated Ringer'snever sterile water. The key rule: keep the final concentration at or above 0.89 mg/mL so the liposomes remain effective. Expansion isn't about adding more medicine; it's about distributing the existing dose more evenly across tissues.

How it's given

Infiltration technique basics

Layered, slow infiltration; aspirate to avoid intravascular injection

During wound closure, your surgeon or anesthesiologist injects Exparel in small amounts, moving through layers of tissue. They'll pull back on the syringe (aspirate) before each injection to be sure it's not in a blood vessel. Slow, layered infiltration helps reduce hot spots and creates more even numbness.

Regional block considerations

Indications limited to specific blocks; ultrasound guidance; avoid off-label routes

For the three approved adult nerve blocks, ultrasound guidance is typicalit's like GPS for the needle, improving precision and safety. Off-label routes (like epidurals or spinal injections) are a no-go with Exparel because of safety concerns and lack of evidence.

Admixing with bupivacaine HCl for early onset

Allowed ratios (bupivacaine HCl:Exparel 1:2), timing, total volume math

Mixing a small amount of plain bupivacaine HCl with Exparel can provide quicker onset while Exparel ramps up. The safe rule: the ratio of bupivacaine HCl to Exparel should be 1:2 or less (for example, up to 75 mg bupivacaine HCl with 150 mg Exparel). Your team will track total local anesthetic dose to avoid toxicityit all adds up.

Wait times and incompatibilities (e.g., lidocainewait 20 minutes before Exparel)

Lidocaine and Exparel don't play nicely if mixed together directly. If lidocaine is used first, clinicians should wait at least 20 minutes before injecting Exparel at the same site to avoid disrupting the liposomes. Also avoid mixing Exparel with other drugs in the same syringe unless compatibility is clear.

Practical prep and handling

Resuspension (invert vial), dilution limits, storage, do-not-use scenarios

The vial is gently inverted to resuspend the liposomes before drawing up. If expanded for volume, saline or lactated Ringer's are used, staying at or above the 0.89 mg/mL concentration. Single-dose vials mean once they're opened and used, they're discarded. Do-not-use scenarios include visible clumping after proper resuspension, unknown compatibility mixtures, or routes the drug isn't approved for.

Personalized dosing

Patient-specific factors

Age, weight (pediatrics), hepatic/renal function, cardiovascular status

Exparel dosage is not one-size-fits-all. Your weight (for kids), liver function, cardiac history, and overall medical status all matter. If you have significant liver impairment, your team may reduce dosage or choose alternatives. The same goes for severe heart rhythm issues or certain rare enzyme problems.

Surgical site considerations

Site size, vascularity, and neuroanatomy drive volume and dispersion

Surgeries with larger or more vascular areas may need more volume and careful placement. For example, a broad abdominal incision benefits from layered infiltration along the entire wound, while a focused shoulder procedure may rely on a single interscalene block at 133 mg.

Concomitant anesthetics and analgesics

Avoid other local anesthetics within 96 hours; opioid-sparing strategies

Because Exparel releases bupivacaine slowly, you should avoid receiving additional local anesthetics for about 96 hours unless your team explicitly decides it's necessary and safe. Many teams pair Exparel with non-opioid pain meds (acetaminophen, NSAIDs if appropriate) to reduce opioid needs while keeping you comfortable.

Benefits vs risks

Potential benefits

Longer pain control (up to 45 days), reduced opioid need, earlier mobility

Most people feel steadier pain relief for several daysoften through the most painful window after surgery. That can mean fewer opioids, less nausea, and a smoother path to walking, eating, and sleeping a bit more normally.

Risks and limitations

CNS/cardiac toxicity with overdose or intravascular injection

Like all local anesthetics, bupivacaine can be dangerous at high blood levels. Symptoms can include ringing in the ears, metallic taste, numb lips, dizziness, seizures, or abnormal heart rhythms. Careful technique and dosing minimize these risks.

Temporary sensory/motor loss; not for intra-articular use (chondrolysis risk)

Expect temporary numbness and sometimes weakness in the area covered by a block. Also important: Exparel should not be injected into joints because of the risk of cartilage damage. Your team will stick to approved routes to keep you safe.

Contraindicated in obstetrical paracervical block; caution in hepatic disease

Exparel is not for paracervical blocks in obstetrics and should be used carefully in people with significant liver problems. Always share your full medical history so your team can tailor your plan.

Red flags and when to call the doctor

Symptoms of toxicity, allergic reactions, methemoglobinemia signs

Seek urgent help for severe dizziness, confusion, seizures, chest pain, shortness of breath, or a racing or very slow heartbeat. Call your team for hives, swelling of lips or tongue, or a rash. Very rarely, local anesthetics can trigger methemoglobinemiawatch for gray or blue skin, headache, fatigue, or shortness of breath.

Side effects guide

Common side effects by route

Infiltration: nausea, constipation, vomiting

After infiltration at the surgical site, the most common effects are nausea, vomiting, and constipationthough these can also come from anesthesia, opioids, or the surgery itself.

Nerve blocks: nausea, fever, headache, constipation

For nerve blocks, you may also see mild fever or headache. Most effects are self-limited and manageable at home with routine post-op care.

Pediatric infiltration: nausea, vomiting, constipation; others possible

Kids can experience similar symptomsnausea, vomiting, constipationwith the addition of the usual hurdles of getting comfortable and staying hydrated. Care teams dose by weight to keep things safe.

Less common but serious effects

Seizures, arrhythmias, cardiovascular depression, allergic reactions

Serious reactions are rare but require immediate medical attention. If you notice sudden confusion, fainting, severe chest symptoms, or a seizure, call emergency services.

Practical tips

Hydration, early ambulation guidance, when to seek urgent care

Drink fluids, eat small frequent meals, and follow your team's plan for walking and deep breathing. Use scheduled non-opioid meds if prescribed. If pain suddenly spikes when numbness fades, that can be normalhave your backup plan ready. Seek urgent care if you experience severe, unusual symptoms as noted above.

Clinician checklists

Adult dosing cheatsheet

Infiltration max 266 mg; interscalene 133 mg; adductor canal 133 mg + 50 mg bupivacaine HCl; sciatic 133 mg

Key caps: don't exceed 266 mg for infiltration. Approved adult blocks are interscalene 133 mg, adductor canal 133 mg plus up to 50 mg bupivacaine HCl (1:2 ratio), and sciatic at popliteal fossa 133 mg.

Pediatric infiltration calculator prompts

4 mg/kg up to 266 mg; example calculations

Simple prompt: weight in kg 4 mg/kg = total mg (cap at 266 mg). For a 30-kg child, dose would be up to 120 mg. Expand with saline/LR to cover the incision, keeping concentration 0.89 mg/mL.

Admix and expand safely

Ratios, total volume planning, minimum concentration

When admixing bupivacaine HCl for early onset, keep the HCl:Exparel ratio 1:2. Expand with saline/LR to reach desired volume and coverage, maintaining 0.89 mg/mL. Avoid mixing Exparel with lidocaine in the same syringe; if lidocaine is used first, wait 20 minutes before Exparel at the same site.

Safety guardrails

Avoid off-label routes; monitoring plan; emergency readiness

Stick to approved indications and routes. Use ultrasound guidance for blocks. Monitor for CNS or cardiac signs of local anesthetic systemic toxicity (LAST), and have resuscitation equipment and lipid emulsion therapy readily available.

Real-world notes

Patient stories and recovery timelines

Example: hernia repair vs knee arthroplasty experiences

Two quick snapshots. After an open hernia repair, one patient described the pain as "muted" for two dayshe used acetaminophen on schedule and saved his limited opioid prescription for bedtime. By day three, he felt more soreness but still manageable. Contrast that with a knee arthroplasty patient who had an adductor canal block: day one was comfortable; day two's discomfort crept up as numbness eased; day three required a couple of opioid doses, then she transitioned back to non-opioids. Different surgeries, different arcsbut both felt more in control with a plan.

Surgeon tips for setting expectations

Talking about numbness windows, breakthrough pain, and at-home care

Surgeons often say: plan for the "handoff" when numbness fades. Keep scheduled non-opioids going, start icing, and move within your limits. Know your rescue planwhat you'll take, when you'll call, and what symptoms mean "head to the ER." Clear expectations turn surprises into mild speed bumps, not roadblocks.

Cost and access

Where it's used

Where Exparel is typically used (OR, ASC, hospital)

Exparel is typically administered in the operating room or procedure area at hospitals and ambulatory surgery centers. You won't pick it up at a pharmacyit's stocked and billed by the facility.

Ask and plan

Questions to ask your care team and insurer

Before surgery, ask: Will Exparel be used for my case? What is my Exparel dosage and route? Will you admix with bupivacaine HCl? Are there any out-of-pocket costs? If Exparel isn't covered, what are the alternatives? Being proactive helps avoid billing surprises and ensures your pain plan fits your goals.

If you love digging into original sources, clinicians often reference the FDA-approved label and manufacturer dosing pages when planning Exparel administration. According to the full prescribing information and the manufacturer's professional dosing guidance, the dosages and compatibility rules above reflect the current standard of care.

A quick recap

Exparel dosage isn't one-size-fits-all. It depends on the procedure, the site being treated, and your health profile. In adults, local infiltration generally tops out at 266 mg, while certain nerve blocks use 133 mgand kids 6 to under 17 years are dosed by weight at 4 mg/kg (max 266 mg). When used correctly, Exparel can deliver days of steadier pain relief and help reduce opioid needs. But like any anesthetic, it carries risksso compatibility rules, careful administration, and monitoring really matter.

Are you scheduled for surgery? Ask your team how they determine your Exparel dosage, whether they'll admix bupivacaine HCl, and what side effects to watch for. If you want a personalized, printable checklist or quick dosing prompts for a pediatric case, tell me the procedure and age/weightI'm happy to draft one with you. What worries you most about post-op pain? What's worked for you in past recoveries? Let's make a plan you feel good about.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.