Does diluting Exparel for use in more than one area decrease the efficacy of the drug?

When using Exparel to treat two areas such as in a mommy makeover; tummy tuck and breast augmentation it has been suggested that one vial be diluted to treat both areas. Does diluting one vial decrease the efficacy of the drug by either strength and/or duration?

Doctor Answers 8

Diluting Exparel Does this matter?

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Hi Only1

Whenever one dilutes a drug, it has the potential to decrease the effectiveness.  On the other hand, there is a maximum amount of medication (milligrams/kilogram) that can be used before toxic levels are reached.

I am not familiar with your weight and particular issues, so I would encourage you to think of it this way.  The real benefit to Exparel is the fact that it is very long lasting.  Diluting won 't affect this.  Therefore, you will still get a good result potentially, however discuss this with the one who knows- your doctor.

Good luck on the tuck neighbor.


Does diluting Exparel for use in more than one area decrease the efficacy of the drug?

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Exparel is not meant to be used in a diluted form. How well it will work is likely significantly reduced if that is done. Otherwise you will need two doses to cover the area.

Efficacy of Exparel

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I've performed some of the initial studies on Exparel in plastic surgery. I assure you that one vial is effective to treat both areas.  I usually dilute a 20cc vial up to 120cc to cover both areas. I have found that it can often reduce up to 70% of the immediate postop discomfort in the first 3 days after surgery. This helps reduce the amount of oral narcotics required (and their side effects), sooner ambulation, and faster recovery.

Hope this helps and best wishes!

Dr. Morales

ABPS Board Certified Plastic Surgeon

Houston, Tx

Does diluting Exparel for use in more than one area decrease the efficacy of the drug?

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Thank you for sharing your excellent question.  According to the manufacturer diluting the product neither impacts its effectiveness or duration.  The covered anesthetic molecules simply disperse over a greater area but still remain active.  Hope this helps.

Can exparel be diluted

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Thank you for asking about your Exparel.

  • Diluting exparel is like diluting any local anesthetic -
  • It makes it less effective although the duration of action is likely to be the same.
  • There are various dilution options for Exparel.
  • There are also safety limits on how much can be used at one time.
  • At our hospital, the cost of Exparel has come down 75% - so now we give the drug based on safety limits, not cost
  • Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Does diluting Exparel decrease efficacy?

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In my experience, Exparel can be diluted to different levels and still work fine.  The dilution technique that the manufacturer recommends would be more than sufficient to treat both your breasts and your tummy.  I have used different dilutions and seen no difference in how effective it is, thus the injection technique is probably more important than the dilution.  Best of luck!

Exparel dilution

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Exparel (1 vial) can be diluted safely 200-250cc and still maintain its efficacy in multiple areas.  Unlike other medications where excessive dilution can potentially decrease effectiveness, exparel is a special liposomal release bupivicaine (translation: the active numbing medicine is in a special release construct that very slowly releases over time (up to 72 hours or more of effects).   Proper Dilution of Exparel does NOT decrease its effectiveness.   Please see a board certified plastic surgeon with extensive experience with Exparel to learn more about your options.  Best wishes,

Dr. Basu
Houston, TX

Use of Exparel

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Exparel is a local anesthetic formulated so that a slow release of the medication is allowed over time. Exparel gives great postoperative relief for about 72 hours after surgeries. The main safety concern of any local anesthetic is toxicity. So overdosing is what we worry about from a safety standpoint. One vial is calculated to be a safe dose of local anesthetic for a patient of " average weight". So , "diluting" allows us to use the medication in multiple areas . ( Same dosage in a larger volume) . The key is to inject in the appropriate places, rather than the total volume in order for the medication to provide the best anesthetic potential. One vial for a tummy tuck and breast augmentation is sufficient . 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.