Topical Anaesthetic Strategies for Pain Management in Chronic Leg Ulcers

Chronic leg ulcers represent a significant burden on patients and healthcare systems worldwide, often characterised by persistent pain that impairs mobility, sleep and quality of life. Topical anaesthetic strategies seek to deliver effective analgesia directly to the wound bed, minimising systemic side effects and reducing dependence on oral opioids. Approaches include traditional local-anaesthetic creams (such as lidocaine, prilocaine mixtures and eutectic formulations), volatile anaesthetics reformulated for cutaneous use and novel delivery systems like adhesive patches or controlled-release dressings. Recent advances emphasise rapid onset of action, sustained analgesic duration and compatibility with routine wound care. Cost-effectiveness analyses, case series and early clinical trials have highlighted the potential of topical sevoflurane and high-concentration lidocaine preparations to provide meaningful pain relief, facilitate wound debridement and permit opioid dose reduction. Continued development focuses on optimising drug penetration, assessing long-term safety and integrating pain relief with ulcer healing protocols.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Topical Anaesthetic Strategies for Pain Management in Chronic Leg Ulcers publication trend

The graph below shows the total number of articles in topical anaesthetic strategies for pain management in chronic leg ulcers across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic leg ulcer: A full-thickness break in the skin on the lower leg persisting for more than six weeks despite standard care.

Topical anaesthetic: A local drug formulation applied to the skin or wound surface to inhibit nerve conduction and relieve pain.

Sevoflurane: A volatile inhalational anaesthetic repurposed in liquid form for direct application to painful skin lesions.

Nociception: The neural process of detecting and transmitting signals in response to harmful or potentially harmful stimuli.

Opioid-sparing effect: The reduction in systemic opioid requirements achieved by supplementing with alternative analgesic therapies.

References

1. Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers. PLOS ONE (2021).
2. Pain management & opioid dose reduction with topical sevoflurane instillations in intractable venous ulcers: a case report. Brazilian Journal of Pharmaceutical Sciences (2022).
3. A randomised, double‐blind, placebo‐controlled study to determine the analgesic efficacy, safety and tolerability of VPX638 administered topically to painful wounds. Wound Repair and Regeneration (2025).