Lidocaine Analgesia for Removal of Wound Vacuum-Assisted Closure Dressings

Abstract

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.