title: Novel methods of local anesthetic delivery in the perioperative and postoperative setting-potential for fibrin hydrogel delivery.
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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland. Electronic address: laurakearney@rcsi.ie.
authors.forename: Laura
authors.initials: L
authors.lastname: Kearney
authors.affiliation: Centre for Research in Vascular Biology, University College Cork, Cork, Ireland. Electronic address: derekwhelan2009@gmail.com.
authors.forename: Derek
authors.initials: D
authors.lastname: Whelan
authors.affiliation: Department of Anaesthetics, Cork University Hospital, Cork, Ireland; ASSERT for Health Centre, University College Cork. Electronic address: briodnl@gmail.com.
authors.forename: Brian D
authors.initials: BD
authors.lastname: O'Donnell
authors.affiliation: Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland; Centre for Research in Vascular Biology, University College Cork, Cork, Ireland. Electronic address: J.clover@ucc.ie.
authors.forename: Anthony J P
authors.initials: AJ
authors.lastname: Clover
mesh_terms: D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods*; D005337:Fibrin / Q000737:chemistry*; D006801:Humans; D020100:Hydrogels / Q000737:chemistry*; D008081:Liposomes; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D019990:Perioperative Care / Q000379:methods*; D011184:Postoperative Period
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D020100:Hydrogels; D008081:Liposomes; D005337:Fibrin
keywords: Fibrin; Local anesthetic; Postoperative analgesia