Novel methods of local anesthetic delivery in the perioperative and postoperative setting—potential for fibrin hydrogel delivery

• Published in: Journal of clinical anesthesia Vol. 35; pp. 246 - 252
• Main Authors: Kearney, Laura, MB, MRCS, Mch, Whelan, Derek, BEng, MSc, O'Donnell, Brian D., MB, MSc, MD, FCARCSI, Clover, Anthony J.P., B Med Sci, BM BS, MRCS, MD, FRCS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016; Elsevier Limited
• Subjects: Analgesia, Epidural; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia & Perioperative Care; Anesthesia, Local - methods; Anesthetics, Local - administration & dosage; Bone surgery; Clinical medicine; Drug Delivery Systems - methods; Fibrin; Fibrin - chemistry; Humans; Hydrogels; Hydrogels - chemistry; Infections; Liposomes; Local anesthesia; Local anesthetic; Manufacturing; Narcotics; Nervous system; Pain management; Pain Management - methods; Pain Medicine; Pain, Postoperative - drug therapy; Patient satisfaction; Perioperative Care - methods; Plastic surgery; Polymers; Postoperative analgesia; Postoperative Period; Skin & tissue grafts; Local anesthetic; Fibrin; Postoperative analgesia
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.07.033

Abstract The benefits of high-quality postoperative analgesia are well documented and include earlier mobilization, fewer respiratory and cardiovascular complications, and shorter hospital stay. Local anesthesia–based acute pain regimens are at worst equal to and at best superior to opiate-based regimens from the perspective of analgesia. A multimodal approach limiting opioids by combining with local anesthetics has additional beneficial effect on outcomes such as nausea and vomiting, pruritus, gastrointestinal function, respiratory complications, and neutrophil function. Wound catheters providing continuous infiltration of local anesthetics offer a rational approach to effective perioperative analgesia, but their use is limited by a short duration of action. There is an identified need for further methods to optimize longer-acting delivery of these agents. This article reviews current and evolving longer-acting techniques and their limitations with particular focus on the potential advantages of a fibrin hydrogel–based system.