psd-502 and Varicose-Ulcer

Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used.. To determine the effects of topical agents or dressings for pain in venous leg ulcers.. For this third update the following databases were searched: Cochrane Wounds Group Specialised Register (searched 9 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4); Ovid MEDLINE (2009 to April Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 08, 2012); Ovid EMBASE (2009 to 2012 Week 18); and EBSCO CINAHL (2009 to May 2 2012). No date or language restrictions were applied.. Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of topical agents or dressing for the treatment of pain in venous ulcers were included.. Two review authors independently performed trial selection, data extraction and risk of bias assessment.. Six trials (343 participants) evaluated Eutectic Mixture of Local Anaesthetics (EMLA): lidocaine-prilocaine cream for the pain associated with ulcer debridement. The between-group difference in pain measured on a 100 mm scale was statistically significant in favour of EMLA (MD -20.65, 95% CI -12.19 to -29.11). No significant between-group differences in burning or itching were observed.Two trials (470 participants with venous leg ulcers) evaluated ibuprofen slow-release foam dressings for persistent venous leg ulcer pain. Compared with local best practice, significantly more participants in the ibuprofen dressing group achieved the outcome of >50% of the total maximum pain relief score between day 1 and day 5 than participants in the local best practice group (RR 1.63, 95% CI 1.24 to 2.15). The number needed to treat was 6 (95% CI 4 to 12). In the second trial, compared with an identical non-ibuprofen foam dressing, there was no statistically significant difference in the proportion of participants experiencing slight to complete pain relief on the first evening of treatment.Limited data were available to assess healing rates or adverse events.. There is some evidence to suggest that ibuprofen dressings may offer pain relief to people with painful venous leg ulcers. EMLA (5%) appears to provide effective pain relief during the debridement of venous leg ulcers. Further research should consider standardised pain assessment methods and assess both the effect on ulcer healing and the impact of long term use of these treatments.

Topics: Administration, Topical; Analgesics; Anesthetics, Local; Bandages; Debridement; Humans; Ibuprofen; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine; Randomized Controlled Trials as Topic; Varicose Ulcer

Topics: Analgesics, Non-Narcotic; Anesthetics, Local; Bandages; Cross-Over Studies; Debridement; Humans; Ibuprofen; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain Management; Pain Measurement; Prilocaine; Quality of Life; Randomized Controlled Trials as Topic; Varicose Ulcer

A granulating surface is important for skin grafting and healing of leg ulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain.. Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its safety after repeated doses.. In this randomized double-blind, placebo-controlled study, 69 patients with venous leg ulcers received cream before debridement until a clean ulcer was obtained (or a maximum of 15 debridements).. EMLA decreased the median number of debridements required for a clean ulcer (EMLA 11.5, placebo >15; P = .019) and decreased pain by 50% (P = .003). Plasma levels of lidocaine, prilocaine, and their main metabolites were low without any apparent accumulation.. EMLA produces effective pain relief for the debridement of leg ulcers and shortens the time to a clean ulcer.

Topics: Administration, Cutaneous; Aged; Anesthetics, Local; Debridement; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Time Factors; Treatment Outcome; Varicose Ulcer; Wound Healing

Topics: Aged; Anesthetics, Local; Debridement; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Prilocaine; Varicose Ulcer

Repeated topical analgesia with EMLA 5% cream prior to the cleansing of venous leg ulcers was studied. Patients were randomly allocated to a series of 8 treatments with EMLA (n = 22) or to a control group (n = 21). A thick layer of the cream was applied to the ulcers for 30 min. At each of the 8 treatments, local reactions were assessed on a 4-point scale and pain from ulcer cleansing on a visual analogue scale. At the first and the last treatment the area of the ulcer was determined by mapping, a sample for a bacterial culture was taken and the amount of dead tissue, slough and granulation tissue present was assessed. Treatment with EMLA for 30 min significantly decreased the pain from cleansing of the leg ulcers and the frequency of post-cleansing pain. The analgesic effect remained unchanged with successive treatments. Repeated treatment with EMLA in leg ulcers would appear to be safe, as indicated by the absence of any serious untoward events. No statistically significant differences in local reactions or adverse effects on granulation tissue, ulcer area or bacterial flora were observed in the EMLA-treated patients compared with the control patients.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Debridement; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain Measurement; Prilocaine; Prospective Studies; Varicose Ulcer; Wound Healing

Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer.

Topics: Analgesics; Bandages; Drug Therapy, Combination; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Prilocaine; Varicose Ulcer; Wound Healing