For many patients, anxiety about surgery begins well before the procedure itself. They may worry about what recovery will feel like, how long pain may last, and how much time they’ll be away from work, family, exercise, or the activities they enjoy.
Each year, roughly one in nine Americans undergoes at least one surgical procedure. But the frequency does little to ease those concerns, particularly for procedures associated with significant postsurgical pain.
For years, opioids have been considered a standard part of managing pain after surgery. While they can be a valuable tool for some patients, their use also comes with risks and concerns, especially amid the nation’s ongoing overdose crisis. In 2023, opioids were a factor in at least seven out of every 10 overdose deaths nationally. The impact has been especially high in Washington, D.C., where the age-adjusted rate of opioid-associated overdose deaths ranked third highest among U.S. states and jurisdictions.
With these concerns in mind, patients and doctors are increasingly looking for options that may help reduce or delay the need for opioids.
Finding an Alternative
One local doctor taking this approach is Dr. Sanford Littwin, who is focused on helping patients manage postsurgical pain while limiting their reliance on opioids. As chief of anesthesiology at GW Health System’s Cedar Hill Regional Medical Center, Dr. Littwin has spent more than 20 years helping patients navigate their recovery.
A key part of his approach is using EXPAREL® (bupivacaine liposome injectable suspension), a long-acting, non-opioid local anesthetic administered at the time of surgery. Injected directly into the surgical site, EXPAREL slowly releases local anesthetic to provide targeted, extended pain relief during the first few days after surgery, when pain is typically at its worst.
Dr. Littwin uses EXPAREL in approximately 300 procedures each year and has found it particularly helpful for certain shoulder surgeries. He saw its potential firsthand when his chief of surgery injured his shoulder in a bicycle accident, which required an operation. As part of the patient’s pain management plan, Dr. Littwin administered EXPAREL and said the patient experienced minimal discomfort in his shoulder during the first few days of recovery.
The experience reinforced the value of having a long-acting, local anesthetic option available to help manage pain during the early stages of recovery.
In Dr. Littwin’s practice, this approach has helped reduce the need for opioids, and in some cases, avoid them altogether.
“It’s changed how patients experience surgical recovery,” Dr. Littwin said. “The goal is always to help patients ease back into their normal routines, and minimizing pain can play an important role in that. In my experience, patients have been able to move more comfortably through the first few days after surgery with EXPAREL as part of their pain management plan.”
Bringing Non-Opioid Options to D.C.
At Cedar Hill Regional, Dr. Littwin is looking to expand the use of EXPAREL beyond his own practice now that it’s available hospital-wide. He plans to educate colleagues on how it may be used more broadly, particularly as the hospital’s orthopedic program grows.
Dr. Littwin advises D.C. residents, including older adults who may be more likely to need surgery, to speak with their doctors about a postsurgical pain management plan and whether a non-opioid option like EXPAREL may be appropriate.
Questions he recommends asking include:
• How do you plan to manage my pain after surgery, both in the hospital and once I’m home?
• What can we do to minimize or delay my need for opioids? Would alternative options make sense in my situation?
• What are the potential risks or side effects of a non-opioid option, and how do they compare to what I might experience with opioids?
By asking questions before surgery and planning ahead for recovery, patients can take a more active role in their care and feel more prepared for what comes next.
*Dr. Littwin is a consultant for Pacira BioSciences, Inc., the manufacturer of EXPAREL. This is based on Dr. Littwin’s experiences. Individual patient experience may vary.
INDICATION
EXPAREL® (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks.
IMPORTANT SAFETY INFORMATION
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, headache, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
Please refer to full Prescribing Information.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
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© 2026 Pacira Pharmaceuticals, Inc., a wholly owned subsidiary of Pacira BioSciences, Inc. EXPAREL is a registered trademark of Pacira Pharmaceuticals, Inc., a wholly owned subsidiary of Pacira BioSciences, Inc. All rights reserved.
PP-EX-US-10688 09/26
