Lidocaine Analgesia for Removal of Wound Vacuum-Assisted Closure Dressings
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT. Journal of orthopaedic trauma
(Impact Factor: 1.8).
02/2013; 27(2):107-12. DOI: 10.1097/BOT.0b013e318251219c
: Wound vacuum-assisted closure (VAC) is a technique used frequently by orthopedic surgeons to facilitate wound closure. Bedside VAC removal can be a source of great pain for patients, which we hypothesize can be decreased by topical lidocaine application.
: This was a prospective randomized double-blinded, placebo-controlled trial (registered on clinicaltrials.gov), utilizing the crossover intervention technique.
: The study was carried out at a level 1 trauma center.
: Nondiabetic, adult patients requiring at least 2 extremity wound VAC dressing changes were involved.
: In a double-blinded fashion, topical lidocaine (1%) was compared with topical normal saline (0.9% NaCl) after injection into the VAC sponge. The crossover intervention technique, wherein each patient received an independent VAC change with lidocaine and saline, served to control for all possible patient characteristics. Randomization determined which sample was given first or second.
: The patients were evaluated for visual analog pain scores, narcotic requirement, and wound characteristics.
: A total of 11 patients were enrolled for a total of 21 VAC changes (mean wound size 133 cm); 1 patient withdrew after his first VAC dressing was changed with saline. Controlling for pre-VAC change pain, the lidocaine intervention was associated with 2.4 points less on the 0-10 visual analog scale for pain (P value <0.001, -3.0 to -1.7) and 1.7 mg less morphine-equivalents administered (P value <0.001, -2.3 to -1.1) during the VAC sponge removal.
: The patients undergoing an extremity wound VAC dressing removal at the bedside should be pretreated with topical lidocaine because it decreases pain and narcotic requirements.
: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Available from: Richard J Bodnar
[Show abstract] [Hide abstract]
ABSTRACT: This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
Available from: Richard S. Yoon
[Show abstract] [Hide abstract]
ABSTRACT: Negative pressure wound therapy (NPWT) is a useful management tool in the treatment of traumatic wounds and high-risk incisions after surgery. Since its development nearly 2 decades ago, uses and indications of NPWT have expanded, allowing its use in a variety of clinical scenarios. In addition to providing a brief summary on its mechanism of action, this article provides a focused, algorithmic approach on the use of NPWT by reviewing the available data, the appropriate clinical scenarios and indications, and the specific strategies that can be used to maximize outcomes.
Copyright © 2015 Elsevier Inc. All rights reserved.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.