Pericapsular Exparel for Pain Relief in Bunionectomy and Related Procedures

The investigators propose a prospective, randomized, single-blinded study of patients who
are electing to undergo an outpatient first metatarsophalangeal (MTP) joint procedure
(bunionectomy, 1st MTP fusion, or cheilectomy). As a standard, patients undergoing these
procedures are given regional anesthesia (adductor canal block plus popliteal block).
Patients are then given prescriptions for oral opioids to manage post-operative pain. The
purpose of this study is to determine whether a single intrapopliteal administration of
Exparel, in conjunction with the standard of care regional block, improves pain relief and
therefore decreases use of post-operative opioids.

Inclusion Criteria:

- Age ≥ 18

- Undergoing distal or midshaft osteotomy for bunion correction, 1st MTP Fusion, or
cheilectomy

Exclusion Criteria:

- Age less than 18

- Unable to read/write English

- Dementia, history of dementia, or other significant mental impairment that would, in
the opinion of the investigator, impede patient self-reporting

- Weight <70 kg

- Allergy to local anesthetics

- History of long-acting opioid use or opioid tolerance (any patient receiving at least
30 mg of oxycodone or equivalent per day (e.g., 6 tabs of Percocet 5/325 mg)
regularly for approximately 7 days or more OR who require increased analgesic doses
for a period long enough to develop tolerance to the effects of the opioid including
analgesia and sedation)

- Any history of opioid misuse, illicit or prescription

- Prior MTP joint correction on the surgical limb

- Midfoot and hindfoot procedures performed concurrently, on the same day

- Pregnant or breastfeeding