As of January 1st 2020, I offer Exparel local anesthetic during His Choice Vasectomy procedures. Exparel is an long acting local anesthetic and works for up to 72 hours (3 days) after administration. Using Exparel can make a great vasectomy technique even better!

Prior to using Exparel, I used bupivacaine local anesthetic during vasectomy procedures. Bupivacaine was previously known as one of the longer acting local anesthetics but bupivacaine only provides anesthesia for up to 4 hours after vasectomy.

Exparel is more expensive but I believe using Exparel can offer an improvement in pain control after vasectomy.

Exparel and Vasectomy: What is Exparel? Is it safe?

Bupivacaine was the historical gold standard for longer acting anesthetics but bupivacaine only provided pain relief for 4 to 8 hours after administration.

Exparel was approved by the Federal Drug Administration in 2011 and is quickly becoming the standard of care for long acting local anesthesia after many major surgical procedures. Exparel is liposomal bupivacaine.

A liposome is a really small, spherical phospholipid structure. The inside of the liposome contains the local anesthetic bupivacaine (the same bupivacaine anesthetic I used before). The bupivacaine inside the liposome is slowly released over 72 hours and this is how Exparel provides extended pain control. The liposome particle itself is slowly degraded and absorbed by your body.

Although understanding a liposome may seem complex, imagine placing olive oil in a glass jar with water and shaking vigorously. Eventually the oil will form small spheres and these small spheres of oil droplets are similar to liposomes. The only differences are pharmaceutical liposomes are smaller, more stable, and don’t disperse as fast as oil droplets do in water.

For more information: Learn more about extended release Exparel

Exparel has been demonstrated to be safe, has the ability to provide extended pain relief, and has been shown to decrease pain and pain medication usage after many major surgical procedures.

Pain and His Choice Vasectomy: What’s the deal?

There are two types of guys who will read this information. There are those who will say:

• “Cool….I am down with that!”
• “Damn honey, I knew that vasectomy shit was painful…they even have to use pain medication that last for 3 days!”

I would like to set the record straight.

Most of my patients, even before using Exparel, do not experience significant pain during or after His Choice Vasectomy. I do not routinely provide narcotic pain medication or anti-anxiety medications before, during, or after vasectomy.

Pain and His Choice Vasectomy: What are the facts?

I email patients a survey 1 month after their His Choice Vasectomy procedure. I ask patients to rate their pain during their vasectomy and the day after their vasectomy on a scale of 1 to 10 (1 is no pain and 10 is worse pain imaginable).

This is how patients report pain during their His Choice Vasectomy Procedure:

• Approximately 25% report no pain
• Approximately 64% report mild pain
• Approximately 10% report moderate pain

Bottom line: Most patients, approximately 90%, report very little pain during His Choice Vasectomy.
“Vasectomy does not have to be a painful experience… Honey!”

The following pie chart demonstrates what patients report about pain the day after their vasectomy procedures.
These are patients who did not have the extended release local anesthetic.

Patient reported pain 24 hours after vasectomy procedures

Average pain rating the day after procedure 3.2
Scale of 0 (none) to 10 (severe)

This is how our patients having vasectomy with the short acting local anesthetic reported their pain the day after their His Choice Vasectomy procedures:

• Approximately 6% report no pain
• Approximately 74% report mild pain
• Approximately 19% report moderate pain
• Approximately 1% report severe pain

Some pain after vasectomy is to be expected. Most pain can easily be treated with over the counter medications. So the average patient does not have a horrible experience after vasectomy.

Starting January 2020 all patients will get both the short acting local anesthetic and the long acting extended release anesthetic. 

The goal is to get more patients into the “No pain” category during the first 72 hours and also, hopefully, eliminate the 1% of patients who report severe pain after His Choice Vasectomy.

Exparel And Vasectomy: Was your pilot trained by Navy or Air Force?

Exparel has the potential to make vasectomy an even smoother experience for patients. Using Exparel is not necessary but has the potential to improve the vasectomy experience for some men.

I have been told you can tell where an airplane pilot got their training based on how they land their airplanes.

• Navy pilots commonly land on aircraft carriers and are more accustomed to short, ‘hard’ landings.
• Air Force pilots commonly land on long, land based runways and are more accustomed to long smooth landings.

Although both pilots will get you on the ground safely… wouldn’t you prefer a smooth soft landing?

Exparel has the potential to make after vasectomy landings smoother for vasectomy patients.