Pain Management in Pediatric Patients during Negative Pressure Wound Therapy Dressing Changes

Purpose: To determine the efficacy of Lidocaine Hydrochloride topical solution to reduce pain in pediatric Patients during Negative Pressue Wound Therapy (NPWT) Dressing changes.

Problem:The use of NPWT has increased in the pediatric patient. NPWT dressing changes can be very painful. Dressing chagnes occur three times a week until the wound defict has filled with granulation tissue or healed. Wound care mesurements to reduce pain have included using contact layers, injecting normal saline into the foam prior to removal. Conventional measures to reduce pain include analgesics taken by mouth 30 minutes plus prior to the dressing change or Intravenous pain medication such as Fentanly of Morphine. These efforts to reduce pain have futile. Many of our patients with very low pain tolerancehave their dressing changed in the operarting room under anesthesia.

Method: A topical Lidocaine Hydrochloride solution was instilled into the NPWT foam for at least thirty minutes prior to the removal of the black foam. This solution was used on eight patients six female and two malesranging in ages from one year to seveteenyears of age. Age appropriate pain scores were taken before and during and after removal of the foam.

Results: Pain score were report at zero prior to the removal of the foam in all patients. Pain scores were reported to be between zero and two from our sample patients during the removal of the foam. The topical Lidocaine Hydrochloride solution was utilized as a wound care measure and all eight patients did not require conventionla measures to reduce pain. 

Conclusion: A topical Lidocaine Hydrochloride solution can be effective in pain management in the pediatric patient during NPWT dressing changes.

Recommendations: Further research and studies are needed on this teatment in the pediartic population.