Lidocaine Application on Open Wounds
Lidocaine can be safely applied directly to open wounds before injection, with LET (lidocaine, epinephrine, tetracaine) solution or gel being the recommended option for providing anesthesia in 10-20 minutes. 1
Recommended Application Methods
- For open wounds, apply 3 mL of LET solution (for patients >17 kg) directly to the wound and cover with an occlusive dressing, or place a cotton ball soaked with LET solution into the wound 1
- Allow LET to remain in contact with the wound for 10-20 minutes or until wound edges appear blanched for optimal anesthetic effect 1
- For pediatric patients, use weight-appropriate dosing: 0.175 mL/kg of LET solution for patients <17 kg 1
- 5% lidocaine cream has been shown to be effective for wound pain relief with good safety and tolerability in various wound types 2
Safety Considerations and Contraindications
- Do not use lidocaine products if there is a known allergy to amide anesthetics 1
- Be cautious with grossly contaminated wounds when using LET solution as it may reduce effectiveness and increase infection risk 1
- Avoid using multiple forms of lidocaine simultaneously (e.g., cream and patch) to prevent potential toxicity 1
- Do not apply topical lidocaine products within 4 hours of other local anesthetic interventions 1, 3
- FDA labeling warns against using topical lidocaine on large areas of the body, cut, irritated or swollen skin, or puncture wounds 4
- Monitor for signs of systemic absorption such as dizziness, confusion, or bradycardia, especially when applying to larger wound areas 1
Efficacy Considerations
- LET solution provides anesthesia in 10-20 minutes, making it superior to other options for wound pain management 1
- While lidocaine-soaked gauzes can provide some pain relief (reducing pain scores from 3.3 to 2.2 in one study), they cannot completely replace infiltration anesthesia for procedures like suturing 5
- For wounds requiring vacuum-assisted closure dressing removal, topical lidocaine application has been shown to decrease pain and narcotic requirements 6
Alternative Options
- For intact skin around wounds, EMLA cream requires 60 minutes under occlusion for full effectiveness 7
- Liposomal 4% lidocaine cream (LMX4) provides anesthesia in approximately 30 minutes 7
- Heat-activated anesthetic systems can work in as little as 10-20 minutes 7
Common Pitfalls to Avoid
- Applying lidocaine products to grossly contaminated wounds may reduce effectiveness and increase infection risk 1
- Failing to allow sufficient contact time (10-20 minutes for LET, 60 minutes for EMLA) will result in inadequate anesthesia 1, 7
- Using multiple lidocaine-containing products simultaneously increases the risk of systemic toxicity 1
- Topical anesthetics alone may not provide complete pain relief for all procedures and may need supplementation with other methods 1
- Rare cases of serious burns have been reported with topical lidocaine products 4
Wound Healing Considerations
- Research suggests that lidocaine/prilocaine cream may not have adverse effects on wound healing and might even have beneficial effects in an incisional wound model 8
- Discontinue use and consult a doctor if condition worsens, redness is present, irritation develops, or symptoms persist for more than 7 days 4