Long-Acting Local Anesthesia: An Opportunity to Reduce or Eliminate Opioids in the Postoperative Setting

Inflammation and pain after surgery is part of the body’s normal healing process. During the first

72 Hours

after surgery, when pain is most severe,

pain signals from the incision site to the central nervous system (CNS) are intensified by inflammation.1-4

To block pain signals being transmitted to the CNS, most local anesthetics are administered at the incision site. However, increased tissue acidity caused by inflammation limits currently available local anesthetics from penetrating impacted nerve cells

inhibiting their ability to relieve pain beyond 12-24 hours.5-7

12-24 Hours

Failing to block pain signals during the first 72 hours can amplify their transmission to the CNS,

Increased Pain

leading to increased pain and an overreliance on opioids.8-9

Unlike local anesthetics, opioids act on the opiate receptors in the brain and can reduce the sensation of pain, but do not block transmission of the pain signals.

Hyper-Stimulated Nerves

This can lead to nerves becoming hyperstimulated, possibly resulting in chronic pain.8-9

An overreliance on opioids is causing serious clinical repercussions, including:

Opioid Events

Increased number of opioid-related adverse drug events (ORADES) that lead to higher costs and impaired patient recovery.10,12

Opioid Use

Postsurgical chronic pain, persistent opioid use and opioid use disorder.10-13

Opioid Cost

More than $23.4 billion in annual healthcare costs associated with persistent opioid users can be attributed to postoperative pain management.12,14

Learn more about ZYNRELEF® for the reduction of postoperative pain.

View References

  1. Ueno T, et al. Local anesthetic failure associated with inflammation: verification of the acidosis mechanism and the hypothetic participation of inflammatory peroxynitrite.J Inflammation Res. 2008;1:41-48.
  2. Becker DE, et al. Essentials of local anesthetic pharmacology. Anesth Prog. 2006;53(3):98-108.
  3. Lynch EP, et al. Patient experience of pain after elective noncardiac surgery. Anesth Analg. 1997;85(1):117-123.
  4. Svensson I, et al. Assessment of pain experiences after elective surgery. J Pain Symptom Manage. 2000;20(3):193-201.
  5. Enoch S, et al. Basic science of wound healing. Surg (Oxford). 2008;26(2):31-37.
  6. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 2004;140(6):441-451.
  7. Golf M, et al. A phase 3, randomized, placebo-controlled trial of DepoFoam® bupivacaine (extended-release bupivacaine local analgesic) in bunionectomy. Adv Ther. 2011;28(9):776-788.
  8. Pathan H, et al. Basic opioid pharmacology: an update. Br J Pain. 2012;6(1):11-16.
  9. Ramachandran SK, et al. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23:207-213.
  10. Hill MV, et al. Wide variation and excessive dosage of opioids prescriptions for common general surgical procedures. Ann Surg. 2017;26(4):709-714. doi:10.1097/SLA. 0000000000001993
  11. The Council of Economic Advisers, 2017. The Underestimated Cost of the Opioid Crisis. Accessed January 14, 2021. https://www.whitehouse.gov/briefings-statements/cea-report-underestimated-cost-opioid-crisis
  12. Brummett CM, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504
  13. Banta-Green CJ, et al. Opioid use behaviors, mental health and pain – development of a typology of chronic pain patients. Drug Alcohol Dependence. 2009;104(1-2):34-42. doi:10.1016/j.drugalcdep.2009.03.021
  14. Brummett CM, Evans-Shields J, England C, Kong AM, Lew CR, Henriques C, Zimmerman NM, Sun EC. Increased health care costs associated with new persistent opioid use after major surgery in opioid-naive patients. J Manag Care Spec Pharm. 2021 Feb 24:1-12. doi: 10.18553/jmcp.2021.20507. Epub ahead of print. PMID: 33624534.

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