Wound Pain Relief Research Articles

A randomized, double-blind, prospective study to assess lidocaine jelly for pain control during Mohs surgery

A randomized, double-blind, prospective study to assess lidocaine jelly for pain control during Mohs surgery

Use of Infrared Light Fomentation for Pain Relief in Postpartum Mothers with Episiotomy

Background: Post delivery is decisive period for post-partum women who had undergone episiotomywhich is a throbbing and disquiet procedure during this time. So the aim of the study is to appraise the effectof infrared light fomentation therapy on episiotomy wound pain relief among postpartum women.Aim: To asses the level of episiotomy wound pain among postpartum mothers before and after infraredfomentation.Methodology:1. The study participants will be selected among postpartum mothers having normal vaginal delivery withepisiotomy within 2 hours.2. Accordingly 30 postpartum Women will be randomly selected and allocated into matched groups.3. Written consent will be obtained from recruited Postpartum mothers.4. Intensive Phase:a. Twice a day until the fourth day morning infrared lamp and normal episiotomy wound care (twospoons betadine in 4 glasses of water).b. Best and worst levels of pain will be measured using 10 pain scale from 0(none) – 10(severe).5. Technique of procedure: Infrared light will be placed 45cm away from the perineum and heat emittedwith 220V will be used for 10-15 minutes then pain will be assessed.6. Appraising phase: The results will be compared for the 4 following days follow up of infraredfomentation therapy in postpartum mothers with episiotomy.Results: The study show that the intensity of pain decreased with the infrared light fomentation on episiotomyhad good results and pain relief is seen at the end of 4th day of follow up.Conclusion: Post-partum women who apply infrared lamp therapy on episiotomy display faster pain reliefthan those who do not.

5% Lidocaine Hydrochloride Cream for Wound Pain Relief: A Multicentre Observational Study

Background Lidocaine hydrochloride is frequently used for management of painful wounds. This prospective, multicentre study examined the effects of 5% lidocaine cream on wound pain relief. Material and methods The study included 78 patients with painful wounds treated with 5% Lidocaine cream for two weeks in two Italian Hospitals. Patients’ perception of pain was recorded by, using the 5-point Visual Rate Scale and the 11-point Numerical Pain Rating Scale. All medications and adverse events were evaluated in a daily diary. The primary outcome of the study was establishing the wound pain relief based on the results of 5-VRS and pain intensity based on the 11-NPRS testing from baseline to the end of treatment. Clinical aspects and adverse events were also collected. Results Seventy-eight patients had a median age of 67.5 years (range 18-96 years). 62.8% were women. The wounds included traumatic wounds (n = 39), venous ulcers (n = 25), post-surgical wounds (n = 6) pyoderma gangrenosum (n = 6), vasculitis (n = 1) and pressure ulcer (n = 1). The intensity of pain significantly decreased from the baseline level established at the beginning of treatment (mean score 6.7 − 1.90) - to the level at end of treatment (3.0 − 2.23-; p < 0.0001). 9 patients prematurely stopped the treatment for healing (n = 4), wound improvement (n = 2) and adverse events related to the treatment. (n = 3). 13 patients presented a total of 25 adverse events, 4 of them were related to the treatment. Conclusion The treatment of painful wounds with 5% Lidocaine Cream for 14 days resulted in reduced pain intensity, and showed high safety and tolerability.

PCL microsphere/PEG‐based composite hydrogels for sustained release of methadone hydrochloride

ABSTRACTHydrogels have increasingly received considerable attention for local opioids delivery in order to sustained wound pain relief. However, burst release of drugs is a critical problem of hydrogels. To this aim, a local drug delivery system consisting of polycaprolactone (PCL) microspheres containing methadone hydrochloride/polyethylene glycol (PEG)‐based hydrogels were developed to prolong drug release with potential utilization in pain treatment. Four different drug delivery systems, including methadone hydrochloride/PEG‐(N3)4‐based hydrogel, methadone hydrochloride/PEG‐(N3)2‐based hydrogel, methadone hydrochloride/PCL/PEG‐(N3)4, and methadone hydrochloride/PCL/PEG‐(N3)2 composite hydrogels, were fabricated to investigate drug release profiles of these systems. The results showed that drug released can be controlled by both the double‐barrier matrix (hydrogel/microsphere), and the crosslinking density of hydrogels. Therefore, methadone hydrochloride/PCL/PEG‐(N3)2 composite hydrogel with high crosslinking density has great potential application in sustained release systems for wound pain relief. © 2020 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2020, 137, 48967.

Observation of curative effect of recombinant human basic fibroblast growth factor combined with compound polymyxin B ointment and local application of insulin on wound healing of deep second-degree burn in diabetes mellitus: a randomized study.

We aimed at investigating the clinical efficacy of recombinant human basic fibroblast growth factor combined with compound polymyxin B ointment and the local application of insulin on wound healing of deep second-degree burn in diabetes mellitus. 80 diabetes mellitus patients complicated with deep second-degree burn treated from 2016 to December 2017 were selected and divided into observation group (n=40) and control group (n=40) using the random number method. Patients in control group were treated with compound polymyxin B ointment, while those in observation group were treated with basic fibroblast growth factor based on the treatment in control group. The time of wound pain relief, wound scarring, and wound healing was compared. The number of positive bacteria in the wound was recorded and the duration of infection was also recorded. Moreover, the changes in the expressions of Advanced Glycation End products (AGEs) and Vascular Endothelial Growth Factor (VEGF) were analyzed. In observation group, the time of wound pain relief, wound scarring, and wound healing was significantly shorter than that in control group (p<0.05). At 3, 14, and 28 days after the treatment, the levels of AGEs in observation group were lower than those in control group, while the levels of VEGF in the observation group were higher than those in control group (p<0.05). The proportions of wound infection, skin necrosis, systemic blood infection, hypoglycemia, and hyperglycemia and the ineffective rate in observation group were significantly lower than that in control group (p<0.05). The application of compound polymyxin B ointment and the local application of insulin combined with recombinant human basic fibroblast growth factor in diabetes mellitus patients complicated with a deep second-degree burn can effectively alleviate the pain, reduce the wound infection rate, promote the wound healing, and improve the overall therapeutic effect.

Evaluation of Gentamicin and Lidocaine Release Profile from Gum Acacia-crosslinked-poly(2-hydroxyethylmethacrylate)-carbopol Based Hydrogels.

No doubt, the prevention of infection is an indispensable aspect of the wound management, but, simultaneous wound pain relief is also required. Therefore, herein this article, incorporation of antibiotic agent 'gentamicin' and pain relieving agent 'lidocaine' into hydrogel wound dressings, prepared by using acacia gum, carbopol and poly(2-hydroxyethylmethacrylate) polymers, has been carried out. The hydrogels were evaluated as a drug carrier for model drugs gentamicin and lidocaine. Synthesis of hydrogel wound dressing was carried out by free radical polymerization technique. The drug loading was carried out by swelling equilibrium method and gel strength of hydrogels was measured by a texture analyzer. Porous microstructure of the hydrogel was observed in cryo-SEM images. The hydrogel showed mesh size 37.29 nm, cross-link density 2.19× 10-5 mol/cm3, molecular weight between two cross-links 60.25× 10-3 g/mol and gel strength 0.625±0.112 N in simulated wound fluid. It is concluded that the pH of swelling medium has influenced the network structure of hydrogel i.e., molecular weight of the polymer chain between two neighboring cross links, crosslink density and the corresponding mesh size. A good correlation was established between gel strength and network parameters. Cryo-SEM images showed porous morphology of hydrogels. These hydrogels were found to be biodegradable and antimicrobial in nature. Drug release occurred through Fickian diffusion mechanism and release profile was best fitted in first order model. Overall it is concluded that modification in GA has led to formation of a porous hydrogels for wound dressing applications.

Incidence, natural course, and characteristics of postlaparoscopic shoulder pain.

To determine the incidence, natural course, and specific characteristics of postlaparoscopic shoulder pain (PLSP). The prospective study included 105 patients undergoing laparoscopy for benign gynecologic diseases. The intensity of pain, and the identification of the pain site, was assessed 24- and 48-h after surgery, using a visual analogue scale. The description and intensity of PLSP, its aggravating and relieving factors, and the response to analgesics were assessed over a 1-week period using a self-reported questionnaire. Of 105 patients, 84 (80%) experienced PLSP. PLSP along with wound pain peaked one day after surgery, gradually subsided, and were not reported by the seventh day after surgery. Of the 84 patients experiencing PLSP, 77 (91.7%) had aggravating and relieving factors, which included position change (48.8%) and rest (42.9%), respectively. Analgesics provided significantly less pain relief for PLSP (32.7±32.2%), when compared to relief of wound pain (68.0±16.2%) (P<0.001). PLSP, identified in 80% of our patients, resolved in most patients within the first week after laparoscopy. Since PLSP is less responsive to analgesics, when compared to wound pain, surgeons should pay attention to the prevention of PLSP among patients undergoing laparoscopy.

The effect of Ringer's solution within a dressing to elicit pain relief.

Clinical studies suggest that dressings containing Ringer's solution, such as the TenderWet and HydroClean families, provide relief from wound pain. This report reviews the available evidence and possible mechanisms for the relief of wound pain by these dressings. The ability of dressings containing Ringer's solution to provide pain relief is likely to be through providing a moist environment that is favourable for wound healing; furthermore, the dressing augments the protective barrier function by having additional fluid under the dressing, which covers exposed nerve endings and protects against friction damage. Ringer's solution will have a dilution effect and an influence on the pH of exudate. Diluting cytokines within the exudate would be expected to decrease inflammation in chronic wounds and reduce the influence of caustic components such as matrix metalloproteases (MMPs). Altering the pH of the wound bed could inactivate proteins and glycoproteins implicated in the pain response such as MMPs and sodium and calcium channels. The moist environment may also be better at recruiting leukocytes that release natural painkillers at areas of injury. These mechanisms are likely to act in combination to explain why dressings containing Ringer's solution can have analgesic effects.

Effect of lidocaine hydrochloride gel combined with infrared ray therapeutic equipment for wound pain relief

Objective To investigate the effect of lidocaine hydrochloride gel combined with infrared ray therapeutic equipment for wound pain relief, and find out the best intervention plan. Methods A total of 212 cases of patients with wound were randomly divided into four groups by random number table: group A (n=55) put lidocaine gel five minutes on wound and then treated five minutes of infrared ray, group B (n=52) using five minutes lidocaine gel and treated infrared ray at the same time, group C (n=54) using infrared ray to treat and then put five minutes lidocaine gel on the wound, group D (n=53) using lidocaine gel five minutes. Visual analogue scale (VAS) was used to assess the level of pain before, middle and after intervention and count the operation time of nurses in four groups. Results The pain score of group B was (2.66 ± 2.64), better than that in group A (3.01±2.18), C (3.16±2.32) and D (3.66±2.49) (F=3.28, P<0.05). The consumption of operation time in the group D was least compared with the other three groups (F=393.29, P<0.05). Conclusions The most obvious pain relief is the group B, but the least consumption of operation time is group D, so nurses can choose different intervention according to work requirements. Key words: Lidocaine hydrochloride gel; Infrared ray therapeutic equipment; Wound pain

The Effectiveness of Aromatherapy with Lavender Essential Oil in Relieving Post Arthroscopy Pain

Research literature regarding the effectiveness of lavender essential oil aromatherapy in reducing postoperative surgical wound pain is limited and the results are inconsistent. The aim of this study was to examine the effectiveness of aromatherapy with 2% lavender essential oil via bottle necklace for postoperative arthroscopic knee wound pain relief. This was a time series experimental design study comprised of two groups. Twenty eight patients comprising the experimental group were given bottle necklaces filled with 0.5ml of 2% lavender essential oil, while thirty two participants of the control group were given empty bottle necklaces to wear. Aromatherapy with 2% lavender essential oil via bottle necklace effectively reduced pain for a long term (72 hours) use, and there were differences in the rate of pain decline between the experimental and control groups. There are no significant findings of groups (experimental group/control group) at 15 minutes, 4, 8, 24, and 48 hours. However, the reduction slope of pain score at the 72th hour after recovery from anesthesia in the experimental group was significantly greater than that of the control group. The pain scores of the experimental group decreased from 6.9 to 1.8, while the pain ratings of the control group decreased to 3.5 from 6.4. This approach to postoperative arthroscopic surgery knee wound pain relief is not recommended for immediate effect, but for a long term use (at least 72 hours after recovery from anesthesia). Future research should aim at establishing standards of aromatherapy care.

Hot Water Immersion Therapy with a Thermal Isolator in Patient with Marine Envenomation

ObjectiveHot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI.MethodWe first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in‐vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored.ResultsIn our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time.ConclusionOur purposed thermal isolator is a safe, practical and effective device for HWI therapy.

Mucosa advancement flap anoplasty in treatment of chronic anal fissures: a prospective, multicenter, randomized controlled trial

Anal fissure is one of the most common anal-rectum diseases, and approximately 10 percent patients with chronic anal fissure ultimately receive surgery. Relieving postoperative pain and protecting functions of the sphincter are central issues for coloproctologists. To evaluate the efficacy and safety of anoplasty in the treatment of chronic anal fissures. In this prospective, multicenter, randomized controlled trial, 120 adult patients with chronic anal fissure were referred from Department of Coloproctology of Yueyang Hospital of Integrated Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Municipal Hospital of Traditional Chinese Medicine. The patients were enrolled from January 2009 to April 2010 and randomly divided into study (mucosa advancement flap anoplasty, abbreviated as anoplasty) group and control (fissurectomy) group. The two groups were assessed separately, and the main outcome measures were observed for 2 weeks, with a short-term follow-up for 6 weeks. Degree of pain, haemorrhage and anal canal pressure were observed and recorded preoperatively, and on the third day, the fourteenth day and the sixth week postoperatively. The wound healing time was also recorded. Surgical complications of the two groups were recorded and compared on the third day and the sixth week postoperatively. The curative effects associated with the surgery were analyzed on the fourteenth day and the sixth week after surgery and the therapeutic results were evaluated. Three patients were dropped out due to the early discharge from hospital and losing connection (1 in study group and 2 in control group). Overall the surgery showed that the anoplasty group had better results than the fissurectomy group in the curative effect on the sixth week after operation (P<0.05). Time of wound healing in the anoplasty group was (17.22 ± 4.41) d and was better than (21.24 ± 7.44) d of the fissurectomy group (P<0.05). Concerning the relief of wound pain, the anoplasty group achieved better results than the fissurectomy group at the third day, the fourteenth day and the sixth week after operation (P<0.05). Anoplasty reduced bleeding and had better efficacy than the fissurectomy at the third day and the fourteenth day after operation (P<0.05), however, there was no statistical difference at the sixth week after operation (P>0.05). There were no significant differences in relieving the anal canal pressure (P>0.05) and the surgical complications (dysuria, edema of anal margin, fever, infection, anal incontinence and anal deformation) between the two groups (P>0.05). None of the patients suffered postoperative complications by the sixth week after operation. Furthermore, there was no recurrence in either of the two groups at six weeks after operation. The results indicate that anoplasty for chronic anal fissures has advantages such as better therapeutic effects, less postoperative pain, a shorter healing time and no incidence of anal incontinence.

Ibuprofen slow-release foam dressing reduces wound pain in painful exuding wounds: Preliminary findings from an international real-life study

Background: Wound pain is a serious problem for people with chronic wounds. The aim of this real-life study was to compare the effect of a foam dressing that releases ibuprofen (Biatain Ibu®) with local best practice on the treatment of painful exuding wounds. Methods: A total of 185 patients with painful exuding wounds were randomized to either ibuprofen foam treatment (n = 98) or local best practice (n = 87). The primary endpoint was pain relief over 7 days of treatment, assessed daily using a 5-point verbal rating scale (no relief, slight relief, moderate relief, lots of relief, and complete relief). Secondary endpoints included a total reduction in pain intensity for the whole study period (using an 11-point Numeric Box Scale: 0 = no pain to 10 = worst possible pain) and incidence of adverse events (AEs). Results: More patients in the ibuprofen foam treatment group reported wound pain relief and lower wound pain intensity values after 7 days (p < 0.0001 for both variables). Within the four most common ulcer aetiolgies, patients reported significantly more effective pain relief with ibuprofen foam treatment (venous: p = 0.009, mixed arterial venous: p < 0.0001, arterial: p = 0.0009, and vasculitis: p = 0.009). In all groups, patients from the ibuprofen foam group reported lower pain intensities. The results were significant for patients with venous (p < 0.002) and arterial (p < 0.0001) leg ulcers. Two AEs were reported. Conclusions: The ibuprofen foam represents an effective and safe alternative to local best practice in the management of painful exuding wounds.

Effect of an ibuprofen-releasing foam dressing on wound pain: a real-life RCT

To compare an ibuprofen-releasing foam dressing (Biatain Ibu, ColoplastA/S) with local best practice in the treatment of painful exuding wounds. In this large-scale randomised comparative study, 853 patients were randomised to either ibuprofen-releasing foam (test) dressing (n=467) or local best practice (n=386). Primary endpoint was wound pain relief from day 1-7, assessed by the patients twice daily using a five-point verbal rating scale. Secondary endpoints were reduction in pain intensity from day 0-7 (assessed using an 11-point numeric box scale), quality of life (assessed using the WHO-5 well-being index and effect on health-related activities of daily living) and the incidence of adverse events. After seven days significantly more patients in the experimental group experienced relief from temporary and persistent pain and a reduction in pain intensity,when compared with patients in the local best practice group (p<0.0001). They also experienced a greater improvement in quality of life. The number of adverse events in both groups was low. The test dressing provided an appropriate wound healing environment, relieved temporary and persistent wound pain, and decreased pain intensity. It was also associated with an improvement in quality of life.

Organotypic cultures of autologous hair follicle keratinocytes for the treatment of recurrent leg ulcers

Our purpose was to evaluate, in an open study, the efficacy of epidermal equivalents (EEs), a tissue-engineered epidermis prepared from autologous hair follicle keratinocytes, for the treatment of recurrent leg ulcers ( n = 50). To generate EEs, keratinocytes expanded from the outer root sheaths of plucked anagen hair follicles were seeded on cell culture inserts at air-liquid interface. The total culture time was 5 to 6 weeks. Three days after the procedure, 95% of EEs adhered to the wound bed. After 8 weeks, 70% of the total wound surface was re-epithelialized and 32% of the ulcers were healed. After applying the EEs, a major relief of wound pain was noticed by the patients. EEs were applied in ambulatory patients without surgical facilities. Because 92% of the cases included in this study presented a recurrence of their ulcers after a split-thickness skin graft, we consider these ulcers as difficult to treat and propose the EEs as an alternative effective treatment of recurrent leg ulcers. (J Am Acad Dermatol 2003;48:207-14.)

PREOPERATIVE KETAMINE AUGMENTS POSTOPERATIVE PAIN RELIEF BY EPIDURAL MORPHINE IN PATIENTS UNDERGOING GYNECOLOGICAL SURGERIES

S319 INTRODUCTION: Surgical trauma and nerve injury induce NMDA receptor activation, which facilitates nitric oxide production [1], resulting in a hyperalgesic state. Ketamine has an NMDA receptor antagonistic action. Epidural morphine is widely used for postoperative analgesia. In this study, we tested whether preoperative ketamine improved the postoperative pain relief by epidural morphine in patients undergoing gynecological surgeries. METHODS: After institutional approval of the study protocol and the written informed consent from each patient, 45 female patients undergoing gynecological surgeries (transabdominal hysterectomy or oophorectomy) were included in this study. Patients were randomly assigned into one of Pre-Ketamine (n=15), Post-Ketamine (n=15), or Control group (n=15). Epidural catheter was placed at L2/3 interspace. Anesthesia was induced by intravenous thiamylal (5mg/kg), and patients trachea was intubated by the facilitation of vecuronium (0.2mg/kg), iv. Pre-Ketamine group patients were given ketamine, 1 mg/kg, and saline, iv., Post-Ketamine group patients were given saline and ketamine, 1 mg/kg, iv., and Control group patients were given saline and saline iv. at the time of anesthetic induction and 45 min after the start of surgery, respectively. Anesthesia was maintained by epidural 1.5% lidocaine (12ml initially and 3ml every 30min), isoflurane (0.4-1.0%) and 67% nitrous oxide in oxygen. Surgery was started at least 30 min after the anesthetic induction. Postoperatively, pentazocine, 15mg, im., was given for the wound pain relief according to the patient's request. Visual analog pain scale (VAS) value was recorded when patient requested pentazocine, and 6 and 24 hours after surgery. Patients' demographic data, postoperative VAS at 6 and 24 hours, the number of pentazocine requirement and the time at the first pentazocine given during the first 48 postoperative hours were compared among the 3 groups using ANOVA or Kruskal Wallis test. P<0.05 was considered significant. RESULTS: Patients' demographic data were similar among the groups. The main results are summerized in Table 1.Table 1DISCUSSION: This study revealed that preoperative ketamine, 1 mg/kg, iv, augmented postoperative pain relief by epidural morphine. This mechanism is supposed to be ketamine-induced preemptive analgesic effect via NMDA antagonistic action.