title: Anesthesia with topical lidocaine hydrochloride gauzes in acute traumatic wounds in triage, a pilot study.
abstract: BACKGROUND
  Topical application of lidocaine in wounds has been studied in combination with vasoconstrictive additives, but the effect without these additives is unknown. The objective was to examine use of lidocaine-soaked gauzes without vasoconstrictive agents, in traumatic wounds in adult patients, applied in triage.
  
  
  METHODS
  A prospective pilot study was performed during 6 weeks in the Emergency Department of a level 1 trauma center. Wounds of consecutive adult patients were treated with a nursing protocol, consisting of lidocaine hydrochloride administration directly into the wound and leaving a lidocaine-soaked gauze, until wound treatment. Primary outcome was need for infiltration anesthesia. Secondary outcomes were Numerical Rating Scale (NRS) pain scores, adverse events and patient and physician satisfaction.
  
  
  RESULTS
  Forty patients with a traumatic wound were included, 85% male with a wound on the arm. Thirty-seven patients needed a painful procedure as wound treatment. When suturing was necessary, 77% required additional infiltration anesthesia. Mean NRS pain scores decreased from 3.3 to 2.2 after application of the lidocaine gauze. No adverse events were recorded. Of the patients, 60% were satisfied with use of the lidocaine gauzes, compared to 40% of physicians.
  
  
  CONCLUSIONS
  Lidocaine hydrochloride (2%) gauzes without vasoconstrictive additives cannot replace infiltration anesthesia in traumatic wounds.
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.l.ridderikhof@amc.uva.nl.
authors.forename: Milan L
authors.initials: ML
authors.lastname: Ridderikhof
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Noukje
authors.initials: N
authors.lastname: Leenders
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Helma
authors.initials: H
authors.lastname: Goddijn
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Niels W
authors.initials: NW
authors.lastname: Schep
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lirk
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Emergency Department, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
mesh_terms: D000287:Administration, Topical; D000328:Adult; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy*
chemical_list: D008012:Lidocaine
keywords: Anesthesia; Emergency service; Hospital; Lidocaine; Nursing; Pain measurement; Wounds and injuries