Intrasite Gel Research Articles

Evaluation of Pain Relief Outcomes With Topical Applications of 0.1% Morhpine in Intrasite Gel® to Open, Painful Wounds

Evaluation of Pain Relief Outcomes With Topical Applications of 0.1% Morhpine in Intrasite Gel® to Open, Painful Wounds

Study to determine the efficacy of topical morphine on painful chronic skin ulcers

To assess the efficacy of the topical application of morphine on painful chronic skin ulcers. A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a 'rescue' treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily. Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion. The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies.

Stability of morphine sulphate and diamorphine hydrochloride in Intrasite gelTM

Several studies have reported that opioids applied topically to painful ulcers produce an analgesic effect. It is unknown whether these opioids (usually mixed with hydrogels) are stable and, if so, for how long. We investigated the stability of morphine sulphate and diamorphine hydrochloride, each mixed with intrasite gel at a concentration of 1.25 mg/mL. Samples were prepared in the laboratory and then stored in plastic containers in the dark, at room temperature, in conditions of normal day/night at room temperature, and at 4 degrees C. Aliquots were collected from each container over a 28-day period and analysed using HPLC. No known degradation products were measured in the morphine-intrasite gel mixture stored for up to 28 days, irrespective of the temperature and whether or not samples were exposed to light, suggesting that morphine remains stable. Diamorphine, breaks down to morphine and no other degradation products are measurable.

The bioavailability of morphine applied topically to cutaneous ulcers

A number of studies have reported the analgesic effect of morphine when applied topically to painful skin ulcers. It has been suggested that morphine may exert a local action, as opioid receptors have been demonstrated on peripheral nerve terminals. In this study, we investigated the bioavailability of topically applied morphine to cutaneous ulcers. Six hospice inpatients with skin ulcers were given morphine sulfate 10 mg in Intrasite gel topically and morphine sulfate 10 mg subcutaneously over 4 hours, at least 48 hours apart, in randomized order. Morphine, morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) were determined in plasma using a specific HPLC method. In five patients morphine and its metabolites were undetectable when applied topically. In one patient (with the largest ulcer), morphine and M6G were detected. The calculated morphine and M6G bioavailability in this patient were 20% and 21%, respectively. M3G was also detected but was below the lower limit of quantitation. When applied topically to ulcers, morphine was not absorbed in the majority of patients, suggesting any analgesic effect would be mediated locally rather than systemically. However, in ulcers with a large surface area, systemic absorption may occur.

Allergic contact dermatitis in venous leg ulcer patients.

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.

Intrasite Gel and Intrasite Conformable: the hydrogel range

Wound management can be a confusing area of nursing practice. Even when an holistic patient assessment has been undertaken healthcare professionals frequently ask for guidance when faced with choosing the most appropriate wound management product. This article reviews two hydrogels from Smith & Nephew Healthcare — Intrasite Gel and Intrasite Conformable, which is the latest addition to the hydrogel range.

Larval debridement therapy: a cost-effective alternative to hydrogel in necrotic venous ulcers: a randomized trial

Abstract Background Evidence for the effectiveness of larval debridement therapy (LDT) in necrotic wounds has hitherto been the anecdotal results of enthusiasts. The aim of this study was to compare the cost and effectiveness of LDT with standard hydrogel treatment of necrotic venous ulcers. Methods Patients with sloughy venous ulcers were randomized to either standard hydrogel dressings (Intrasite gel) (group 1) or LDT (group 2). All patients were reviewed every 72 h until effective debridement had occurred, for a maximum of 1 month. The outcome measure used for effectiveness was whether or not desloughing occurred and time to deslough. The measures of cost were the cost of nursing time, dressing costs, and costs of larvae and hydrogel required to achieve healing in 1 month's treatment. Results Twelve patients were randomized. Ulcers in all patients receiving LDT (group 2) desloughed within two applications of larva therapy. All of these patients were treated subsequently with four-layer bandaging and all healed within 4 months. Ulcers in only two patients in group 1 desloughed completely within 1 month. One of the patients in whom hydrogel had failed at 1 month was changed to LDT and the ulcer desloughed with one application. Taking into account the cost of a vial of larvae (£58), the overall median cost of treatment in group 1 was greater than that in group 2 (£136·23 (range 63·89–319·30) versus £78·64 (range 73·49–£92·36)). Conclusion LDT is more effective and significantly less expensive than hydrogel in the debridement of sloughy venous ulcers. While a larger randomized controlled study should be performed to confirm these observations, LDT appears to be a cost-effective alternative to hydrogel.

In vitro investigations of a new hydrogel dressing.

The aim of this study was to investigate in vitro the fluid-handling properties of a new hydrogel dressing (Aquaform) and to compare these with the fluid-handling properties of a commonly used hydrogel dressing (Intrasite Gel). The results of laboratory tests indicate that the new hydrogel can absorb substantial amounts of fluid from simulated wet wounds and donate substantial amounts of fluid to simulated dry or necrotic wounds. The amount of fluid exchanged in both wound types for the new hydrogel was similar to that for Intrasite Gel.

Intrasite Gel: a hydrogel dressing.

Intrasite Gel is a hydrogel designed for the debridement of necrotic tissue and effective desloughing, clearing the way for effective wound healing. It is also designed for wounds that are granulating and epithelialising. (Intrasite Gel is a trademark for Smith & Nephew Ltd.).