title: Analgesic efficacy of equimolar 50% nitrous oxide/oxygen gas premix (Kalinox®) as compared with a 5% eutectic mixture of lidocaine/prilocaine (EMLA®) in chronic leg ulcer debridement.
abstract: Chronic foot and leg ulcers are a common health problem worldwide. A mainstay of chronic ulcer therapy is sharp mechanical wound debridement requiring potent analgesia. In this prospective, controlled, single-centre, crossover design study, patients were assigned to either the administration of topical analgesia with 5% lidocaine/prilocaine cream or the inhalation of an analgesic 50% N2O/O2gas premix. Primary outcome parameter was level of pain at maximum wound depth during debridement as measured by a visual analogue scale. Secondary outcomes included level of pain after debridement, overall duration of treatment session, duration and completeness of debridement, and the patient's subjective perception of analgesic quality during debridement. Pain level increased from 0·60/0·94 (first/second debridement; baseline) to 1·76/2·50 (debridement) with 5% lidocaine/prilocaine and from 1·00/1·35 (baseline) to 3·95/3·29 (debridement) with 50% N2O/O2gas premix. Patient satisfaction was 90·48%/94·44% (first/second debridement) with topical 5% lidocaine/prilocaine analgesia and 90·48%/76·47% with the inhalation of 50% N2O/O2gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N2O/O2gas premix (42·86%/58·82%) (odds ratio 6·7; P = 0·001). This study provides sound evidence that analgesia with topically administered 5% lidocaine/prilocaine cream is superior to the use of inhaled 50% N2O/O2gas premix in chronic leg ulcer debridement.
authors: Department of Surgery, Venenklinik Bellevue, Kreuzlingen, Switzerland.
authors: Juerg
authors: J
authors: Traber
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
authors: Ulrike
authors: U
authors: Held
authors: Department of Surgery, Venenklinik Bellevue, Kreuzlingen, Switzerland.
authors: Maria
authors: M
authors: Signer
authors: Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland.
authors: Tobias
authors: T
authors: Huebner
authors: Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland.
authors: Stefan
authors: S
authors: Arndt
authors: Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland.
authors: Thomas A
authors: TA
authors: Neff
mesh_terms: D000280:Administration, Inhalation; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019162:Anesthetics, Combined / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002908:Chronic Disease / Q000628:therapy; D003646:Debridement / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000628:therapy*; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D011318:Prilocaine / Q000627:therapeutic use*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D004338:Drug Combinations; D011318:Prilocaine; D008012:Lidocaine; D009609:Nitrous Oxide
keywords: Analgesia; Chronic leg ulcer; Debridement; EMLA®; Kalinox®