A novel long-acting local anesthetic – HTX-011 (ZYNRELEF^™) for postoperative pain control

ABSTRACT

Introduction

Pain following most surgical procedures is expected. However, the treatment and management of postoperative surgical pain have remained challenging. The use of opioid therapy has become increasingly controversial given the limited therapeutic window of these drugs, the adverse side effects, and the potential for abuse. A multimodal approach to the treatment of postoperative pain has been shown to improve pain outcomes after surgery and improve patient satisfaction. Here, we examine a new formulation of bupivacaine and meloxicam extended-release solution HTX-011 (ZYNRELEF®) and its efficacy in postoperative pain control.

Areas covered

HTX-011 exists as an extended-release polymer that controls the release of the active ingredients over 72 hours. A systematic approach was taken to review PubMed (Medline) for prospective and retrospective studies related to the use of HTX-011 for the management of postoperative pain.

Expert opinion

HTX-011 represents a new tool to help modulate postoperative pain. Although multimodal analgesia has been effective in managing postoperative pain, direct surgical infiltration with local anesthetics has had limited efficacy due to their short duration of action. The HTX-011 formulation provides a long-acting local anesthetic at the surgical site, which provides a longer period of analgesia while maintaining a favorable safety profile.

KEYWORDS:

• Pain
• local anesthetic
• long acting
• depo formulation
• NSAID

Article highlights

• The treatment of pain following surgical procedures has remained challenging. Increasingly, the use of multimodal analgesia has been shown to improve pain outcomes after surgery and improve patient satisfaction.

• Local or intra-articular injection of local anesthetics into the surgical site has shown promise as another method of decreasing postoperative pain. However, its use has been limited by the short duration of action of many local anesthetics.

• A new formulation of bupivacaine and meloxicam extended-release solution HTX-011 (ZYNRELEF®) exists as an extended-release polymer, which is able to control the release of active ingredients over 72 hours.

• This review describes the HTX-011 formulation, the pharmacological properties, and the clinical data currently available in support of the use of this novel solution. Moreover, we explore the limitations of and safety profile of HTX-011.

• Current clinical data suggest that HTX-011 can provide a significantly longer duration of analgesia when compared to plain bupivacaine. Additional studies need to be completed to better understand the safety and efficacy of HTX-011.

Declaration of interest

TJ Gan received honoraria from Edwards, Heron, Medtronic, and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.