In this episode, I’ll discuss topical lidocaine for wound vac dressing changes.
Wound VAC dressing changes can be particularly painful for patients. The wound VAC dressing is a sponge that is placed on top of the wound. During the healing process, the granulation tissue and regenerating nerve endings can grow into the sponge. Significant pain then occurs 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 trial to lower patient-reported pain scores and subsequent prn opioid doses by a significant amount.
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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