37.2 Improved pain control at dressing changes with topical lidocaine and morphine as part of a multidisciplinary team for comprehensive wound pain management

Janet Loitman; Cassandra Ward; Linda Stamm; Laurel Wiersema-Bryant; Pat Dulle; Katie Balella; John P. Kirby; Washington University School of Medicine     

Introduction: Wounds often have a pathophysiologic pain component that we believe should be addressed. We report herein our regimen of local viscous lidocaine and oral morphine applied topically for pain control at dressing changes as part of our overall pain management program. Although many regimens exist, relatively little data exists for a topical pain regimen in concert with more conventional pain medications.

Materials and Methods: Members of our multidisciplinary team rounded on patients with acute and chronic wounds. Although a variety of techniques were applied as needed by the patient's specific medical status and pain complaints, topical agents are often used and detailed herein. Patients needing additional pain control at their dressing changes received a local application of oral morphine sulfate (20 mg/mL) mixed in equal parts with viscous lidocaine over their open wounds. Patients underwent dressing changes with monitoring of pain complaints along an established pain scale and response to treatment as part of our best practice habits.
 
Results: Over the course of the last 6 months approximately 20 patients underwent treatment whose charts were available for review. During and after the dressing changes, both patients and staff enjoyed favorable responses for ease of execution, acceptance of the therapy and pain reduction response. Patients subjectively reported increase ease of dressings and less anxiety associated with dressing changes. No complications were reported in association with this technique.

Conclusion: Adequate attention to pain management is a central tenet to advanced wound care. Our practice habits demonstrate one method of achieving that goal utilizing easily available medications topically. Our data suggest that our pain management regimen augmented by topical lidocaine and morphine is a safe and effective strategy that needs further clinical study to better define its quantitative effects on patient pain and wound healing.