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The price of a painkiller used in knee surgery is getting some doctors bent out of shape.

In recent weeks, two different studies have concluded that the medicine, an analgesic called Exparel, is no more effective than an older form of the treatment. Exparel combines bupivacaine, an injectable drug that has been a standard of care, with a proprietary technique for administering pain relief.


However, the wholesale price for a vial of Exparel costs about $285 versus about $3 for bupivacaine. As a result, the study authors — whose papers were released last month at the annual meeting of the American Association of Hip and Knee Surgeons — maintain the difference in price can’t be justified. Some practices have discontinued using the drug.

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  • I am having a hemorrhoidectomy in a few days and my doctor has offered Exparel @$450, claiming that it will block the pain post surgery for three days. I have searched the internet for days, but have not found one single review on the use of Exparel for this type of surgery. I mentioned it to my family doctor, but he has never heard about Exparel. I do not have much time left to decide whether to go for it and and if is even worth the high cost (not covered by insurance.) Any comments appreciated.

  • I have undergone numerous back surgeries due to multiple congenital abnormalities and I am a medical doctor. My last surgery involved a synovial cyst removal, laminectomy and foraminotomy. I had no, ZERO, post surgical pain! A first for me. Exparel beats the stew out of plain Bupivicaine!

  • Mr. Silverman, I am an anesthesiologist. I do ultrasound guided pain blocks daily. Experal works much longer than $3 bupivicaine. Someone dies from an opioid related death every 20 minutes here in the U.S. The FDA has gotten it wrong in delaying use of this drug for nerve blocks.

  • I am having a knee replacement this week and called my Ortho docs office today to c if they could use Exparel… the long time secretary said
    they had never heard of it!!!
    Is this possible?
    DR John Kavanaugh
    Albany NY


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