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Primary Objective: To evaluate the pharmacokinetics (PK) of EXPAREL in pediatric subjects aged 6 to less than 17 years undergoing various types of surgeries.
Secondary Objective: To evaluate the safety of EXPAREL in pediatric subjects aged 6 to less than 17 years undergoing various types of surgeries.
This is a Phase 3, two-part, multi-center, open-label study designed to evaluate the PK and safety profile of EXPAREL in pediatric subjects aged 6 to less than 17 years when administered intraoperatively at the end of surgery via local infiltration. 90 pediatric subjects undergoing spine and/or cardiac surgeries are planned for enrollment.
Part 1 is a multicenter, randomized, open-label study in subjects aged 6 to less than 17 years undergoing spine or cardiac surgeries. There will be 2 treatment groups: Group 1 will include subjects aged 12 to less than 17 years, while Group 2 will include subjects aged 6 to less than 12 years
Part 2 is a multicenter, randomized, open-label, safety study in subjects aged 6 to less than 17 years undergoing spine or cardiac surgeries. There will be 2 treatment groups: Group 1 will include subjects aged 12 to less than 17 years, while Group 2 will include subjects aged 6 to less than 12 years.
Subjects will be screened within 30 days prior to study drug administration. During the screening visit, subjects will be assessed for past or present neurologic, cardiac, and general medical conditions that, in the opinion of the investigator, would preclude them from study participation.
Subjects will undergo their pre-planned spinal or cardiac surgeries per the institution's standard of care. On Day 1, eligible subjects will receive the study drug intraoperatively at the end of surgery via local infiltration into the surgical site. Dosing of EXPAREL will be based on body weight, with a starting dose of 4 mg/kg (maximum 266 mg).
There is no required length of stay in the hospital; subjects may be discharged based on the medical judgment of the treating physician.
A follow-up phone call will be scheduled for all subjects on Day 7. A final follow-up visit will be made on Day 30 to all subjects who would have received the study drug.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1: 12 to less than 17 years, undergoing spine surgery, EXPAREL | Experimental | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
|
| Group 1: 12 to less than 17 years, undergoing spine surgery, bupivacine | Active Comparator | Single dose of bupivacaine hydrochloride (HCl) 2 mg/kg (not to exceed a maximum total dose of 175 mg) via local infiltration at the end of spine surgery. |
|
| Group 2: 6 to less than 12 years, undergoing spine surgery, EXPAREL | Experimental | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
|
| Group 2: 6 to less than 12 years, undergoing cardiac surgery, EXPAREL | Experimental | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exparel | Drug | EXPAREL 4mg/kg (maximum 266 mg) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Area Under the Plasma Concentration-versus-time Curve (AUC) 0 to Infinity | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) | |
| Maximum Plasma Concentration (Cmax) | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) | |
| The Apparent Terminal Elimination Half-life (t1/2el) | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) | |
| Apparent Clearance (CL/F) | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) | |
| Apparent Volume of Distribution (Vd/F) | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) | |
| Area Under the Plasma Concentration-versus-time Curve (AUC) 0 to Tlast | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
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Inclusion Criteria:
Exclusion Criteria:
Currently pregnant, breastfeeding, or planning to become pregnant during the study or within 1 month after study drug administration.
History of hypersensitivity or idiosyncratic reactions to amide-type local anesthetics or to opioid medication.
Contraindication to bupivacaine HCl or other amide-type local anesthetics or to opioid medication.
Administration of EXPAREL or bupivacaine HCl within 30 days prior to study drug administration.
Subjects with coagulopathies or immunodeficiency disorders.
History of, suspected, or known addiction to or abuse of drugs or alcohol within the past 2 years.
Clinically significant medical or psychiatric disease that, in the opinion of the investigator, indicates an increased vulnerability to study drugs and/or procedures.
Administration of an investigational drug within 30 days or 5 elimination half-lives of such investigational drug, whichever is longer, prior to study drug administration, or planned administration of another investigational product or procedure during the subject's participation in this study.
In addition, the subject will be ineligible to receive study drug if he or she meets the following criterion during surgery:
Any clinically significant event or condition uncovered during the surgery (e.g., excessive bleeding, acute sepsis) that might render the subject medically unstable or complicate the subject's postsurgical course.
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| Name | Affiliation | Role |
|---|---|---|
| Igor Grachev, MD, PhD | Pacira Pharmaceuticals, Inc | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Loma Linda University | Loma Linda | California | 92354 | United States | ||
| Shriners Hospitals for Children, Northern California |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34534923 | Derived | Tirotta CF, de Armendi AJ, Horn ND, Hammer GB, Szczodry M, Matuszczak M, Wang NQ, Scranton R, Ballock RT. A multicenter study to evaluate the pharmacokinetics and safety of liposomal bupivacaine for postsurgical analgesia in pediatric patients aged 6 to less than 17 years (PLAY). J Clin Anesth. 2021 Dec;75:110503. doi: 10.1016/j.jclinane.2021.110503. Epub 2021 Sep 14. |
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Participants were recruited between 02 April 2019 and 24 September 2019 at 15 sites in the US (both Groups).
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| ID | Title | Description |
|---|---|---|
| FG000 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
| FG001 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, Bupivacine |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Oct 1, 2018 | Oct 30, 2020 |
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|
| 0.5% Bupivacaine HCl | Drug | Bupivacaine HCl 2mg/kg |
|
|
| Sacramento |
| California |
| 95817 |
| United States |
| Stanford University | Stanford | California | 94305 | United States |
| Children's Hospital Colorado | Aurora | Colorado | 80045 | United States |
| Nemours / Alfred I. DuPont Hospital for Children | Wilmington | Delaware | 19803 | United States |
| Nicklaus Children's Hospital | Miami | Florida | 33155 | United States |
| Shriners Hospitals for Children-Chicago | Chicago | Illinois | 60707 | United States |
| Riley Hospital for Children at Indiana University Health | Indianapolis | Indiana | 46204 | United States |
| University of Minnesota Masonic Children's Hospital | Minneapolis | Minnesota | 55454 | United States |
| Duke University Medical Center | Durham | North Carolina | 27710 | United States |
| Wake Forest Baptist Health | Winston-Salem | North Carolina | 27157 | United States |
| Cleveland Clinic | Cleveland | Ohio | 44195 | United States |
| University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | 73110 | United States |
| Children's Hospital of Philadelphia | Philadelphia | Pennsylvania | 19104 | United States |
| McGovern Medical School at UTHealth | Houston | Texas | 77030 | United States |
| Southwest Scoliosis Institute | Plano | Texas | 75075 | United States |
| Children's Hospital of Wisconsin | Milwaukee | Wisconsin | 53226 | United States |
Single dose of bupivacaine HCl 2 mg/kg (not to exceed a maximum total dose of 175 mg) via local infiltration at the end of spine surgery. |
| FG002 | Group 2: 6 to Less Than 12 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
| FG003 | Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. |
| COMPLETED |
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| NOT COMPLETED |
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Safety population The Safety population consisted of all subjects who underwent the planned surgery and received study treatment, with analysis by actual treatment received.
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| ID | Title | Description |
|---|---|---|
| BG000 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
| BG001 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, Bupivacine | Single dose of bupivacaine HCl 2 mg/kg (not to exceed a maximum total dose of 175 mg) via local infiltration at the end of spine surgery. |
| BG002 | Group 2: 6 to Less Than 12 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. |
| BG003 | Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Region of Enrollment | Number | participants |
| ||||||||||||||||
| American Society of Anesthesiologists classification | American Society of Anesthesiologists (ASA) classification was determined by physicians using the ASA Physical Status Classification System which assesses the patient's pre-anesthesia medical co-morbidities. ASA 1 patients would be considered a normal, healthy patient. ASA 2 is a patient with mild systemic disease (eg, smoker, well controlled diabetes or high blood pressure (HBP)). ASA 3 is a patient with severe systemic disease (eg poorly controlled diabetes or HBP). ASA 4 is a patient with severe systemic disease that is a constant threat to life (eg, recent myocardial infarction, stroke). | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Area Under the Plasma Concentration-versus-time Curve (AUC) 0 to Infinity | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | ng*h/mL | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
|
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| |||||||||||||||||||||||||||||||||||
| Primary | Maximum Plasma Concentration (Cmax) | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | ng/mL | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
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| Primary | The Apparent Terminal Elimination Half-life (t1/2el) | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | hours | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
| |||||||||||||||||||||||||||||||||||||
| Primary | Apparent Clearance (CL/F) | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | Liters/hour | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
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| Primary | Apparent Volume of Distribution (Vd/F) | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | Liters | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
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| Primary | Area Under the Plasma Concentration-versus-time Curve (AUC) 0 to Tlast | The pharmacokinetic population consisted of subjects who received study drug and provided at least 1 quantifiable plasma concentration, with analysis by actual treatment received. | Posted | Mean | Standard Deviation | ng*h/mL | 15, 30, 45 min, 1-1.25h, 2-4h, 10-18h, 24-36h, 42-60h (spine surgery) or 15, 30, 45 min, 1-1.25, 15-25, 20-40, 45-55, 64-72h (cardiac surgery) |
|
Screening through postsurgical Day 14
An AE was defined as any untoward medical occurrence associated with the use of a drug in humans whether or not considered drug-related. An AE could therefore have been any unfavorable and unintended sign (eg, abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug without any judgment about causality.
Serious AEs were defined as per clinicaltrials.gov.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. | 0 | 31 | 0 | 31 | 19 | 31 |
| EG001 | Group 1: 12 to Less Than 17 Years, Undergoing Spine Surgery, Bupivacaine | Single dose of bupivacaine HCl 2 mg/kg (not to exceed a maximum total dose of 175 mg) via local infiltration at the end of spine surgery. | 0 | 30 | 0 | 30 | 22 | 30 |
| EG002 | Group 2: 6 to Less Than 12 Years, Undergoing Spine Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of spine surgery. | 0 | 5 | 0 | 5 | 5 | 5 |
| EG003 | Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. | 0 | 29 | 2 | 29 | 9 | 29 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Dyspnea | Respiratory, thoracic and mediastinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Wound infection fungal | Infections and infestations | MedDRA (21.1) | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Constipation | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Hypoesthesia oral | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Diarrhea | Gastrointestinal disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Muscle twitching | Musculoskeletal and connective tissue disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Muscle spasms | Musculoskeletal and connective tissue disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Muscular weakness | Musculoskeletal and connective tissue disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Vision blurred | Eye disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Visual impairment | Eye disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Dizziness | Nervous system disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Headache | Nervous system disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Hypoesthesia | Nervous system disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Paresthesia | Nervous system disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Hypotension | Vascular disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Anemia postoperative | Injury, poisoning and procedural complications | MedDRA (21.1) | Systematic Assessment |
| |
| Delayed recovery from anesthesia | Injury, poisoning and procedural complications | MedDRA (21.1) | Systematic Assessment |
| |
| Seroma | Injury, poisoning and procedural complications | MedDRA (21.1) | Systematic Assessment |
| |
| Tachycardia | Cardiac disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Bradycardia | Cardiac disorders | MedDRA (21.1) | Systematic Assessment |
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| Pruritis | Skin and subcutaneous tissue disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Hypoacusis | Ear and labyrinth disorders | MedDRA (21.1) | Systematic Assessment |
| |
| Incontinence | Renal and urinary disorders | MedDRA (21.1) | Systematic Assessment |
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Results conducted at Site shall not be published before 1st multicenter publication by Sponsor but can proceed if there is no such publication ≤18 months after study completion/termination at all sites and all data have been received. Before submitting manuscript/materials to an outside person/entity, site shall give Sponsor 60 days to review and comment. Site shall, upon request, further delay publication/presentation for ≤120 days to allow Sponsor to protect its interests in Inventions.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Pacira Medical Information | Pacira Pharmaceuticals | 1-855-793-9727 | MedInfo@pacira.com |
| Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Oct 30, 2019 | Oct 30, 2020 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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| Male |
|
| Not Hispanic or Latino |
|
| Unknown or Not Reported |
|
| Asian |
|
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
| ASA 2 |
|
| ASA 3 |
|
| OG003 |
| Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL |
Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. Exparel: EXPAREL 4mg/kg (maximum 266 mg) |
|
|
| OG003 | Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. Exparel: EXPAREL 4mg/kg (maximum 266 mg) |
|
|
| OG003 |
| Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL |
Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. Exparel: EXPAREL 4mg/kg (maximum 266 mg) |
|
|
| OG003 |
| Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL |
Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. Exparel: EXPAREL 4mg/kg (maximum 266 mg) |
|
|
| OG003 | Group 2: 6 to Less Than 12 Years, Undergoing Cardiac Surgery, EXPAREL | Single dose of EXPAREL 4 mg/kg (not to exceed a maximum total dose of 266 mg) via local infiltration at the end of cardiac surgery. Exparel: EXPAREL 4mg/kg (maximum 266 mg) |
|
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