Background: Vacuum-assisted closure dressing changes are frequently painful. The authors hypothesized that administering topical lidocaine into the vacuum-assisted closure sponge would decrease pain during dressing changes.
Methods: A double-blind, randomized, prospective study was performed on patients (n = 70) undergoing vacuum-assisted closure dressing changes at a single institution between October of 2003 and June of 2005. Patients were randomized to receive either 0.2% lidocaine or 0.9% saline administered through the vacuum-assisted closure tubing into the foam dressing 30 minutes before changing the dressing. All patients received morphine sulfate ad libitum. Pain scores were assessed according to a 0 to 10 numeric pain scale.
Results: Wound characteristics and patient demographics were similar for both groups. Patients receiving lidocaine reported less pain than control patients during the dressing change (4.3 versus 6.3; p = 0.005) and immediately after (2.4 versus 4.7; p < 0.001) the dressing change. Thirty minutes after the dressing change, pain scores were similar in both groups. Thirty minutes after the dressing change, more patients in the lidocaine group requested small doses of narcotics (>3 mg morphine equivalent) than in the control group.
Conclusions: During the initial vacuum-assisted closure dressing change, 0.2% lidocaine administered through the suction tubing led to a reduction in pain reported by the patients in the authors’ study. The duration of lidocaine administered in this fashion may be fairly short, because more patients in this group began to request small doses of opiates 30 minutes after the dressing change. Thus, lidocaine may improve patient comfort during vacuum-assisted closure therapy.
Chicago, Ill.; Cleveland, Ohio; and Salt Lake City, Utah
From the Departments of Therapy Services and Anesthesiology and Critical Care and the Section of Plastic Surgery, University of Chicago Medical Center; the Department of Plastic Surgery, Cleveland Clinic Foundation; the Division of Plastic Surgery, University of Utah; and the Department of Health Studies, University of Chicago.
Received for publication November 24, 2008; accepted March 12, 2009.
Disclosure: The authors have no financial disclosures.
Robert F. Lohman, M.D., Department of Plastic Surgery, Desk A-60, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, firstname.lastname@example.org