Anesthesia with topical lidocaine hydrochloride gauzes in acute traumatic wounds in triage, a pilot study

• Topical lidocaine is effective in combination with vasoconstrictive additives.
• Utilizing lidocaine hydrochloride-gauzes without these additives in triage is studied.
• When wounds need sutures, these gauzes don't provide adequate anesthesia.

BackgroundTopical application of lidocaine in wounds has been studied in combination with vasoconstrictive additives, but the effect without these additives is unknown. The objective was to examine use of lidocaine-soaked gauzes without vasoconstrictive agents, in traumatic wounds in adult patients, applied in triage.MethodsA prospective pilot study was performed during 6 weeks in the Emergency Department of a level 1 trauma center. Wounds of consecutive adult patients were treated with a nursing protocol, consisting of lidocaine hydrochloride administration directly into the wound and leaving a lidocaine-soaked gauze, until wound treatment. Primary outcome was need for infiltration anesthesia. Secondary outcomes were Numerical Rating Scale (NRS) pain scores, adverse events and patient and physician satisfaction.ResultsForty patients with a traumatic wound were included, 85% male with a wound on the arm. Thirty-seven patients needed a painful procedure as wound treatment. When suturing was necessary, 77% required additional infiltration anesthesia. Mean NRS pain scores decreased from 3.3 to 2.2 after application of the lidocaine gauze. No adverse events were recorded. Of the patients, 60% were satisfied with use of the lidocaine gauzes, compared to 40% of physicians.ConclusionLidocaine hydrochloride (2%) gauzes without vasoconstrictive additives cannot replace infiltration anesthesia in traumatic wounds.