Author(s) : Wolfgang VANSCHEIDT, Zhabeez SADJADI, Stefan LILLIEBORG, Department of Dermatology, Clinic for Wound Biology, Panoramastr. 11-13, DE-79862 Höchenschwand, Germany..
Summary : Sharp debridement is a fast method of achieving a clean leg ulcer, which promotes healing and enables skin grafting. EMLA® cream is the only topical anaesthetic for which there is clinical evidence of analgesic efficacy for debridement. Thirteen clinical investigations of EMLA are reviewed. Four double-blind studies and one open randomised controlled study show that EMLA applied to the ulcer for 30-45 min under occlusion significantly reduces the pain from sharp debridement, decreases the incidence of post-debridement pain and reduces the time needed to achieve a clean ulcer, giving potential savings in healthcare costs. Doses of up to 10 g EMLA result in plasma levels of lidocaine and prilocaine well below toxic levels. Repeated treatment does not change the bacterial flora of the ulcer and rarely causes sensitisation. The treatment of pain in leg ulcer patients is important for patient satisfaction and for patient-perceived quality of life.
Figure 1. VAS pain scores
in EMLA- and placebo-treated patients during sharp debridement over time
(p = 0.003). EMLA decreased pain scores by approximately 50%. From Lok et
al.J Am Acad Dermatol 1999; 40: 208-13. With permission from
the American Academy of Dermatology.
Figure 2. Number of EMLA-
and placebo-treated patients with clean ulcers after a maximum of 15 debridement
sessions (p = 0.008). From Lok et al. J Am Acad Dermatol 1999;
40: 208-13. With permission from the American Academy of Dermatology.
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