Exparel and Beyond: Novel Local Anesthetics, Where We are and What is Coming up

This article reviews recent literature pertaining to local anesthetic formulations, covering medications currently on the market and previewing those expected to debut soon.

Recent pharmacological research in local anesthetics has focused on drug delivery systems to modify the pharmacokinetic properties of existing medications. Liposomal Bupivacaine is the most obvious example of this, as it advertises an increased duration of action while maintaining a good safety profile. However, since coming onto the market in 2011, a multitude of studies performed have shown mixed results as to its efficacy, raising questions as to if its value proposition is worthwhile. Furthermore, studies looking at the efficacy of adjuvant medications such as epinephrine, dexamethasone, and dexmedetomidine have shown promising results when compared to liposomal bupivacaine alone. Other local anesthetic drug delivery systems that have entered the market include extended-release bupivacaine for local infiltration during arthroscopic surgery and a bupivacaine implant for use during hernia repair. Both products thus far have been shown interesting, but limited results.

Further research is needed to truly ascertain the efficacy of these products. This research will be extremely important in the near future, as current clinical trials indicate a deluge of current local anesthetics being brought to market with novel drug delivery systems.