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% N O/O gas 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% N O/O gas 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% N O/O gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N O/O gas 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% N O/O gas premix in chronic leg ulcer debridement.
SummaryTumescent anaesthesia is a widley accepted anaesthetic procedure for the surgery of varicous veins. In our institution tumescent anaesthesia is regularly combined with femoral nerve block or sciatic nerve block for primary operations of the great saphenous vein (GSV) or small saphenous vein (SSV).This combined procedure is described. Retrospective data of 154 operations of the GSV and of 27 operations of the SSV are presented. We used 9.5 mg/kg body weight of prilocain for operations of the GSV and 8.6 mg/kg body weight for operations of the SSV. No serious complications occurred.
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