Novel Topical Techniques and Agents

JET INJECTOR Compressed air high-pressure jet injectors are available to deliver LA agents both in liquid and powder form through the epidermis in a needle-less fashion. This is a delivery method suitable for most skin types and has been used extensively by blood banks to minimize pain during blood donation. There is concern about potential cross infection due to "splash back" when these devices are used on multiple patients without sterilization occurring between each use. However, single dose systems are now available.

IONTOPHORESIS Iontophoresis is a recently developed, single-use delivery system to enhance the speed and depth of delivery of topical LA agents. It also is a needle-less system. However, its effect is variable depending on skin type, thickness, and degree of skin moisture. This system requires specific equipment, is more expensive than the routine topical preparations, and can only be used on intact skin. The anesthetic effect is not immediate and may take up to 15 minutes. The patient may experience a burning sensation under the adhesive electrical pad used for this delivery system.

OTHER PHARMACOLOGIC AGENTS Topical preparations of NSAIDs are being introduced. These preparations are analgesics, not anesthetics. Topical NSAIDs have relatively lower efficacy than oral NSAIDs but also have lower systemic side effects. Another topical agent currently used for chronic pain management that may also have a role in local acute pain management is capsaicin cream, which blocks substance P. There are a number of allopathic preparations available without prescription for topical analgesia, such as aloe and tea-tree oil. Scientific evidence supporting the effectiveness of these preparations is limited. Tea tree oil is toxic if ingested.

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