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

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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