Routine packing of simple cutaneous abscesses is painful and probably unnecessary.
OBJECTIVE
The objective was to determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone.


METHODS
In a prospective, randomized, single-blinded trial, subjects with simple cutaneous abscesses (less than 5 cm largest diameter) underwent incision, drainage, irrigation, and standard abscess preparation in the usual manner. Subjects were then randomized to either packing or no-packing. Visual analog scales (VAS; 100 mm) of pain were recorded in the emergency department (ED). All patients received trimethoprim-sulfamethoxazole (TMP-SMX), ibuprofen, and narcotic prescriptions, recorded twice daily VAS pain scores, and returned in 48 hours at which time dressings and packing, if present, were removed and a physician blinded to the randomization and not part of the initial visit repeated measurements and determined the need for further intervention.


RESULTS
Forty-eight subjects were included in the final analysis. There were no significant differences in age, sex, abscess location, or initial pain scores between the two groups. There was no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) groups (p = 0.72; relative risk = 1.3, 95% confidence interval [CI] = 0.4 to 4.2). Patients in the group that received packing reported higher pain scores immediately postprocedure (mean difference = 23.8 mm; p = 0.014, 95% CI = 5 to 42 mm) and at 48 hours postprocedure (mean difference = 16.4 mm; p = 0.03, 95% CI = 1.6 to 31.2 mm), as well as greater use of ibuprofen (mean difference = 0.32; p = 0.12, 95% CI = -1.4 to 2.0) and oxycodone/acetaminophen (mean difference = 2.19; p = 0.03, 95% CI = 0.2 to 4.1).


CONCLUSIONS
In this pilot study, not packing simple cutaneous abscesses did not result in any increased morbidity, and patients reported less pain and used fewer pain medications than packed patients.
O'Malley
Gerald F
GF
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA. omalleyg@einstein.edu
Dominici
Paul
P
Giraldo
Patricia
P
Aguilera
Elizabeth
E
Verma
Manisha
M
Lares
Claudia
C
Burger
Patricia
P
Williams
Edwin
E
D000038:Abscess / Q000628:therapy*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004322:Drainage; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D012871:Skin Diseases / Q000628:therapy*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000890:Anti-Infective Agents; D009294:Narcotics; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D007052:Ibuprofen