Lidocaine analgesia for removal of wound vacuum-assisted closure dressings:  a randomized double-blinded placebo-controlled trial.
OBJECTIVE
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.


METHODS
This was a prospective randomized double-blinded, placebo-controlled trial (registered on clinicaltrials.gov), utilizing the crossover intervention technique.


METHODS
The study was carried out at a level 1 trauma center.


METHODS
Nondiabetic, adult patients requiring at least 2 extremity wound VAC dressing changes were involved.


METHODS
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.


METHODS
The patients were evaluated for visual analog pain scores, narcotic requirement, and wound characteristics.


RESULTS
: 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.


CONCLUSIONS
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.


METHODS
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
Thomas J
TJ
Christensen
Troy
T
Thorum
Erik N
EN
Kubiak
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local; D018592:Cross-Over Studies; D020878:Device Removal; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010146:Pain / Q000188:drug therapy*; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine