In this episode, I’ll discuss topical lidocaine for wound VAC dressing changes.
Vacuum-assisted closure of wounds uses a device to decrease air pressure on a wound and allow it to heal faster. As part of this process, a wound VAC dressing made of foam or gauze is placed over the wound. During the healing process, the granulation tissue and regenerating nerve endings can grow into the dressing. This can make wound VAC dressing changes particularly painful for patients as significant pain can occur as a result of the sponge being removed.
The addition of topical lidocaine prior to a wound VAC dressing change has been shown in a randomized controlled crossover trial of 11 patients to lower patient-reported pain scores and subsequent prn opioid doses by a significant amount.
In the study lidocaine 1% topical solution was compared with saline. The lidocaine dressing changes resulted in significantly lower pain scores and a reduction in the amount of morphine needed to control pain related to the dressing change.
To utilize lidocaine in this setting, turn off and disconnect the suction canister. Then, 20 minutes before the dressing change, inject topical lidocaine in a retrograde fashion up the wound VAC suction tubing to saturate the sponge. This step should be done prior to manipulating the occlusive dressing. The dose of lidocaine to use is 4.5 mg/kg up to a maximum of 300 mg or 30 mL of a 1% topical solution. This is the generally accepted safe limit for topical lidocaine doses.
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