After surgery to remove the eye, either by enucleation or evisceration, patients have
variable levels of pain for several postoperative days. Some patients have almost no
discomfort while others require significant amounts of oral narcotics and report pain of 10
out of 10 on a numerical rating scale. The current operative standard is to infiltrate the
eye socket with 0.5% bupivacaine during surgery leading to several hours of postoperative
analgesia. In 2011, Pacira Pharmaceuticals released a bupivacaine liposomal injectable
suspension (Exparel, 1.3%) which offers sustained release of bupivacaine giving postoperative
pain control for up to 72 hours. This medication has been used in numerous surgeries
including inguinal hernia repair, hemorrhoidectomy, bunionectomy, breast reconstruction, and
orthopedic surgery, and the literature reports improved pain control, decreased use of oral
opioids, and increased patient satisfaction. There are no reports of the use of Exparel in
the ophthalmic literature. The investigators propose a randomized, controlled trial to
compare the postoperative pain control offered by sustained release bupivacaine to that
offered by standard plain bupivacaine after enucleation or evisceration.