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% 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.

Analgesic effectiveness of topical sevoflurane to perform sharp debridement of painful wounds

“…Reviewing studies involving EMLA, its analgesic effect is also intense, but comparisons with our results are not feasible owing to multiple differences in how and when the effect of EMLA was evaluated in these studies. 6,8,10,[33][34][35][36][37][38][39] Thus, a clinical trial comparing sevoflurane and EMLA cream with respect to their analgesic profiles would be necessary to accurately compare their efficacy profile.…”

Topical anaesthesia for treating pain in chronic wounds: a WHAM evidence summary

“…Two small quasi-experimental studies 6,7 (n = 25 and n = 21, respectively) at moderate risk of bias reported use of lignocaine/prilocaine cream applied pre and post sharp debridement to manage pain in chronic leg ulcers. In people with moderate to severe WRP, daily application of lignocaine/ prilocaine cream prior to performing sharp debridement was well tolerated and reduced the VAS score from 75 to 21 by day ten of treatment.…”

“…Approximately 90% of participants reported overall more comfort and pain relief with lignocaine/ prilocaine cream compared with the inhaled gas . Both studies 6,7 support the use of lignocaine/prilocaine cream for debridement wound pain; however, a combination of both inhaled N 2 O/O 2 and lignocaine/prilocaine cream could be an effective strategy if one treatment is not sufficient 7 (Level 2).…”

“…Level 1 and 3 evidence 1,2 showed a statistically significant improvement in pain relief when applying lignocaine/prilocaine cream or lignocaine hydrochloride cream as a primary dressing, with or without wound procedures being carried out; however, the need for identified larger randomised controlled trials (RCTs) to provide further evidence was identified. Several studies 4,5,6,7 provided Level 1, 2 and 3 evidence that a significant reduction in WRP can be achieved with the use of lignocaine/ prilocaine cream or lignocaine hydrochloride spray/cream during debridement. All studies showed improvement in pain relief, giving practitioners another treatment option for WRP.…”

Utilización del sevoflurano de forma tópica en úlceras de la extremidad inferior: revisión sistematizada

“…• La administración de diversos fármacos con acción analgésica sistémica. Para el dolor moderado y ocasional: analgésicos no opioides; y para el dolor intenso y constante: opiáceos y derivados en sus diferentes formas de presentación, contribuyendo directamente al control analgésico global, aunque pueden producir efectos no deseables 7 .…”