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