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

  • Dental Public Health (R Collins, Section Editor)
  • Published:
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Abstract

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.

Summary

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.

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Authors and Affiliations

  1. Department of Oral Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104-6030, USA

    Elliot V. Hersh

  2. Department of Dentistry/Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, NY, USA

    Mana Saraghi

  3. Department of Dental Pubic Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Paul A. Moore

Authors
  1. Elliot V. Hersh
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  2. Mana Saraghi
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  3. Paul A. Moore
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Corresponding author

Correspondence to Elliot V. Hersh.

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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.

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This article is part of the Topical Collection on Dental Public Health

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Hersh, E.V., Saraghi, M. & Moore, P.A. Two Recent Advances in Local Anesthesia: Intranasal Tetracaine/Oxymetazoline and Liposomal Bupivacaine. Curr Oral Health Rep 4, 189–196 (2017). https://doi.org/10.1007/s40496-017-0144-0

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