Current Oral Health Reports

, Volume 4, Issue 3, pp 189–196 | Cite as

Two Recent Advances in Local Anesthesia: Intranasal Tetracaine/Oxymetazoline and Liposomal Bupivacaine

  • Elliot V. HershEmail author
  • Mana Saraghi
  • Paul A. Moore
Dental Public Health (R Collins, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Dental Public Health


Purpose of Review

This paper reviews the efficacy, safety, and clinical utility of two novel formulations of local anesthetics; intranasal 3% tetracaine plus 0.05% oxymetazoline and 1.3% liposomal bupivacaine.

Recent Findings

Intranasal 3% tetracaine/oxymetazoline when delivered into the ipsilateral nostril of the target tooth has a success rate of 84–90% in completing a single restorative procedure from the second premolar forward. The maximum recommended dose is 18 mg tetracaine/0.3 mg oxymetazoline (three 0.2-ml sprays). The most common adverse effects are nasal congestion and nasal runniness. Liposomal bupivacaine is administered by infiltration injection solely for postoperative pain control and appears to provide analgesic and opioid-sparing effects in knee arthroplasty, bunionectomy, hemorrhoidectomy, and laparotomy. The maximum recommended dose is 20 ml or 266 mg although for dental impaction surgery, a maximum of 10 ml or 133 mg is all that may be required.


Intranasal tetracaine/oxymetazoline is currently FDA approved only for single maxillary restorative procedures in patients weighing 88 lb or greater. Further clinical trials should include more invasive dental procedures and pediatric patients. The utility of liposomal bupivacaine following dental surgery needs to be further explored.


Local anesthesia Tetracaine Oxymetazoline Intranasal drug delivery Liposomal bupivacaine Postoperative pain control 


Compliance with Ethical Standards

Conflict of Interest

Paul Moore reports consulting fees for the preparation of FDA required clinical research protocols during the development of Kovanaze.

Elliot Hersh reports grant support awarded to the University of Pennsylvania from St. Renatus to support data collection.

Mana Saraghi declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

While there is no new human clinical trials reported in this paper, obviously some of the studies cited were in fact my grants and/or Paul Moore's and did receive IRB approval.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Elliot V. Hersh
    • 1
    Email author
  • Mana Saraghi
    • 2
  • Paul A. Moore
    • 3
  1. 1.Department of Oral Surgery and PharmacologyUniversity of Pennsylvania School of Dental MedicinePhiladelphiaUSA
  2. 2.Department of Dentistry/Oral and Maxillofacial SurgeryJacobi Medical CenterBronxUSA
  3. 3.Department of Dental Pubic Health, School of Dental MedicineUniversity of PittsburghPittsburghUSA

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