Topical application of analgesics: a clinical option in day case anaesthesia?

To examine the available and emerging evidence of the use of topically applied analgesics with particular reference to day case anaesthesia.

Current postoperative pain therapy revolves around the use of wound infiltration and systemic administration of opioids, nonsteroidal anti-inflammatory drugs and paracetamol. However, since the origin of postoperative pain is the surgically inflicted wound, there is appeal to localized application of drug to the site of injury, with the hope of enhanced pain relief and a reduction in the side effects associated with systemic administration of drugs. With our enhanced knowledge of the origin and modulation of postoperative pain, it is clear that there are a variety of peripheral targets for our pharmacological interventions. In this review these targets are discussed along with suggestion of which available and emerging drugs are and may be available to interact with these pharmacological targets.

A variety of targets for peripherally applied analgesics exists, some of which can be accessed using currently available drugs, whereas others may need development of new formulations before they can be clinically targeted.