What are the topical treatments for suture-related pain?

From the Guidelines

To manage pain from stitches, apply over-the-counter topical anesthetics containing lidocaine, benzocaine, or prilocaine, as they have been shown to be effective in reducing pain and anxiety in patients with stitches 1. The most recent and highest quality study, published in 2016, recommends the use of topical anesthetics for pain management in dermatologic surgery, including laceration repair 1. Some key points to consider when using topical anesthetics for pain management from stitches include:

• Applying topical anesthetics 20-30 minutes before wound care to allow for optimal absorption and pain relief
• Using products like EMLA cream (2.5% lidocaine/2.5% prilocaine) or LMX4 (4% lidocaine) and following package directions for maximum daily amounts
• Avoiding direct application on open wounds and taking precautions to avoid mucous membrane contact or ingestion
• Considering alternative methods, such as cold compresses or oral pain medications like acetaminophen or ibuprofen, for additional relief
• Monitoring for signs of infection, such as increasing redness, swelling, discharge, or fever, and seeking medical attention if necessary. It's also worth noting that capsaicin, a topical treatment, has been shown to be effective in reducing chronic pain in patients with HIV-associated peripheral neuropathy, but its use for acute pain management from stitches is not well established 1. Overall, the use of topical anesthetics, such as lidocaine, benzocaine, or prilocaine, is a safe and effective way to manage pain from stitches, and patients should follow package directions and take precautions to avoid adverse effects.

From the FDA Drug Label

Warnings For external use only Do not use ◆ on large areas of the body or on cut, irritated or swollen skin When using this product ◆ use only as directed Discontinue use and consult a doctor if ◆ condition worsens ◆ redness is present ◆ irritation develops If pregnant or breast-feeding, ask a health professional before use.

Topical treatment for pain from stitches may be treated with lidocaine (TOP) but caution is advised. The FDA drug label for lidocaine (TOP) 2 warns against using the product on cut, irritated or swollen skin.

• Lidocaine (TOP) may be used to numb away pain, but it is essential to follow the directions and warnings on the label.
• Do not use lidocaine (TOP) on puncture wounds or for more than one week without consulting a doctor.
• If redness, irritation, or condition worsens, discontinue use and consult a doctor.
• It is also recommended to ask a health professional before use if pregnant or breast-feeding.

From the Research

Topical Treatment for Pain from Stitches

• Topical analgesics, such as lidocaine, can be used to treat pain from stitches, including post-surgical wounds 3, 4.
• Studies have shown that topical lidocaine can reduce pain intensity and is well-tolerated in patients with painful wounds, including traumatic wounds, venous ulcers, and post-surgical wounds 3.
• Topical NSAIDs and capsaicin have also been found to be effective in treating various painful conditions, including musculoskeletal pain and neuropathic pain 5.
• The use of topical lidocaine has been supported by clinical practice guidelines, including the American Academy of Neurology and the European Federation of Neurological Societies 6.
• Other topical agents, such as bacitracin, may be used to prevent infection in wounds, but their use as a pain reliever is not well-established 7.

Types of Topical Treatments

• Topical lidocaine creams and patches are available for pain relief, including 5% lidocaine cream and 5% lidocaine patches 6, 3.
• Topical NSAIDs, such as diclofenac and ibuprofen, can be used to treat pain and inflammation 5.
• Capsaicin creams and patches can be used to treat neuropathic pain and musculoskeletal pain 5.

Efficacy and Safety

• Studies have shown that topical lidocaine is effective in reducing pain intensity and is well-tolerated in patients with painful wounds 3, 4.
• Topical NSAIDs and capsaicin have also been found to be effective in treating various painful conditions, with a relatively low risk of adverse events 5.
• The use of topical lidocaine and other topical agents should be guided by clinical practice guidelines and patient-specific factors, such as medical history and current medications 6, 4.