Subcutaneously Administered Anesthetics and Analgesics for Pain Management: An Integrative Review

This article aims to summarize evidence regarding subcutaneously administered anesthetics and analgesics and their effects on pain management. Searches were conducted in September 2023 by a paired review in the MEDLINE database via the Virtual Health Library (BVS) and SCOPUS via Elsevier. Study selection was independently performed by two researchers according to inclusion criteria: primary studies, published in any language, and without temporal restriction. Duplicates, irrelevant studies, and those outside the research scope were excluded, with discrepancies resolved by a third reviewer. The final sample for the review comprised 45 articles, predominantly clinical trials with eligible patients, published between 1982 and 2022. Key drug classes identified in the evaluation of subcutaneous administration for pain management included amide and amino-amide anesthetics, opioids, and adjuvant agents (such as anti-inflammatory drugs, antihypertensives, and catecholamines). Primary advantages noted were reduced postoperative opioid use, effective analgesic control in postoperative settings, adjuvant efficacy in intraoperative settings and invasive exams, fewer cognitive side effects compared to other anesthesia types, decreased coughing, and shorter hospitalization and ambulation times. Disadvantages included subcutaneous bupivacaine's poor adjuvant performance when combined with general anesthesia, tissue necrosis associated with tumescent anesthesia technique, and ambiguity regarding postoperative respiratory function.