| Skin abrasion is one of the most common acute wounds in emergency departments. It’s the friction that causes superficial damage to the skin. The major pathological damage is the injury from cuticular to dermal layer of skin, accompanying with minor bleeder and tissue fluids exudation.According to the degree of cleanliness, wounds can be divided into3types, the clean wound,contaminated wound and infected wound.Acute skin abrasion often happens in accidents.Generally, it is the contaminated wound.Perform debridement in time and trim the inactive skin tissue can remove the foreign bodies and most of the bacterias from the wound, decrease contamination, make it get or close to the clean wound, avoid infection and be beneficial to the morphological and functional recovery of the injury part.Because the abrasion lead to a damage of the natural barrier of skin, make the nerve ending exposure, any external stimulation can lead to obvious pain sensation.Because of the physiological characteristics of skin, adding the physical and chemical irritants, patient would feel severe pain during the process of debridement.The IASP (International Association for the Study of Pain) defined pain as an unpleasant sensation and an emotional experience that associate with the substance or potential tissue damage,or that can be described with tissue damage.Pain is a subjective sensation to noxious stimulation,and it is the result of the action and reaction of people’s rational factors,affective factors and psychological factors.For a trauma patient,intense pain would stimulate the organism create severe stress reactions,and would have an evil influence on patient’s rehabilitation and wound healing.Therefore, solving the problem of pain is one of the key measures that relief the stress reactions and improve patients’ prognosis.Meanwhile it is one of the important measures that promot patient comfort, improve the medical relationship and embody the human-based medical aid.The main measures of solving acute wound pain include physiotherapy, drug therapy and psychotherapy.In resent years, there are documents at home and abroad that introducing analgesic methods of administering drugs on wound surface.Lidocaine and tetracaine are the most commonly used external agents.Synthesize the existing documents, the authors considered that the drug concentration, dose, security, efficiency, pain assessment tool and date comparing methods of these analgesic methods deserved futher improvement and investigation.In the emergency department,the most commonly used pain assessment tools include the Visual Analog Scale (VAS), Numeric Rating Scale,(NRS), and the5-Verbal Descriptor Scale (VDS-5).Comparing with other assessment tools, the VAS is considered to be the more suitable to check the accurate pain level and apply in clinical research.So this study adopted this tool to assess patients’ pain level before and during debridement.ObjectiveInvestigated the effect of2%lidocaine on decreasing the pain level, patients’ acceptance rate of the pain, wound healing time and infection rate when it was administered on the wound surface, so as to prove the efficiency, security, economy and rapidity of lidocaine when being used for solving the problem of pain during debridement.And we hope that this analgesic method can be researched and applied in other types of wound, so as to relief patients’wound-relating pain and promote their physically and mentally healthy.Methods1、Experimental Tools1)2%lidocaine (5ml/ampoule), used as the drug for the experimental group that administered before debridement;2)10ml syringe, used as the drug administering tool;3) VAS, used as the pain assessment tool;4)Sterile cotton swab, used as the supplementary tool when administering drug, avoid the solution overflow from the wound;5)Debridement solution:2%hydrogen peroxide, type3iodine, normal saline, used for washing and disinfecting the wound;6) Sterile medical instruments such as scissors, nipping, curette, the large-size needle, and so on, used for removing the foreign bodies and dead skin tissue on woud;7)Missionary paper on abrasion wound care, used to guide the patients how to protect the wound, keep the wound clean and avoid infection.2、Prepare experiment To assess the feasibility of our research and discover the problems that may come along by the prepare experiment,and find the solutions to the problems for the research’s formal implement.3、Screen and bring research object Took109Patients with acute abrasion wound in emergency department of our hospital between January and September of2011. According to the odd and even number of admission, divided these patients into experimental group (54persons) and control group (55persons) separately.The inclusion criterias were:1)Demands on patient:The patient must be conscious with normal intelligence,aged12-60years,understood and knew how to use the VAS to express their pain level,no lidocaine allergy,no diabetes, the function of heart, liver and kidney was normal, no immune diseases.2) Demands on wound:The wound must be the acute skin abrasion (in6hours after injury), contaminated but not infected, need the regular debridement(The wound had mud or dead tissue for example).Not damage the nerves、main vessels、bones、tendons and muscles, the size was between25-120cm2.4、Wound management for the control group Implemented the routine debridement. The procedure was:washed the wound with2%hydrogen peroxide-normal saline-type3iodine-normal saline; When washing the wound, foreign bodies that can not be washed away could be removed by the sterile medical instruments.The residuary dead skin tissues could be cutted off with a sterile scissors.Dressed the wound with sterile vaseline gauze and dry gauze.5、Wound management for the experimental group Administered2%lidocaine solution on wound surface, implemented the routine debridement5minutes later, the conctete method was as follow.①Calculated the required dosage of the wound:From the prepare experiment we knew that1ml solution was required for every25cm2wound surface.Checked the area of the wound and calculated the dosage that the wound needed.②Administered drug on wound surface: Administered drug on wound surface after the first time pain assessment.Sucked2%lidocaine with a syringe and administered drug on wound surface in drops.If necessary, used the cotton swab as an assisted tool to be sure that the drug could be applied on wound evenly and avoid the drug leaking. Implemented the routine debridement5minutes later.6、Evaluation index Assessed patient’s pain intensity with VAS.VAS is a international tool that is used for pain assessment.It’s10cm in length, anchored by word descriptors at each end.The left hand end of0cm is the starting point that represents ’no pain’. The right hand end of10cm is the ending point that represents ’worst pain imaginable’. Measure in millimetres from the left hand end of the line to the point that the patient marks,the longer the distance, the more severe the pain.In our research, someone used the unified language and guided patient mark on the line according to his/her pain feeling.Assessed patient’s pain scores for the first time before debridemtnt (Described as ’A1’ for the experimental group, and ’A2’ for the control group). Observed and recorded patient’s coordination and resistance during debridement. As soon as the debridement was finished, assessed patient’s pain scores again according to his/her pain feeling during debridement (Described as ’B1’ for the experimental group, and ’B2’ for the control group).Meanwhile sked the patient weather the intensity of pain during was acceptable.Results1、Findings in the prepare experiment:①Patient understood how to used the VAS to express their pain feeling;②Implemented debridement5minutes after administering2%lidocaine on wound surface, it was useful for decreasing the resistance and the intensity of pain during debridement and made the patient cooperate well during the process;③1ml drug solution was needed every25cm2of wound;④0.4ml solution was needed to soaked a cotton swab completely.2、The pain intensity during debridement was obviously higher than that before debridement in both groups (t=8.87, P<0.001for the experimental group and t=27.25, P<0.001for the control group)3、The pain intensity during debridement of the experimental group was obviously lower than that of the control group (t=17.61P<0.001)4、The average healing time of the experimental group was less than that of the control group (t=4.25,P<0.001)5、The experimental group’s acceptance rate of the debridement-relating pain was higher than that of the control group (x2=63.77, P<0.001);6、There was no difference on infection rate of the two groups (P=0.243)Conclusion:1、Patient felt notablely pain during the process of debridement for abrasion wound.2、Have0.2%lidocaine administered on the surface of abrasion wound before debridement could notablely decrease the pain intensity during debridement, control the pain intensith in an acceptable level, decrease the resistance of debridement and make the wound be managed thoroughly.3、Administering2%lidocaine on wound surface could accelerate the process of wound healing but won’t increase the risk of wound infection.4、It’s an economy、effective and safe way that using2%idocaine as a local anesthetic to solve the problem of debridement-relating pain.It’s worthy to be extension and application in clinical practice. |
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