Sharp wound debridement in local anaesthesia using EMLA cream: 6 years?? experience in 1084 patients

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Abstract
Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. During a 6-year period a total of 1084 patients were treated for leg ulcers, decubitus ulcers, abscess revisions, anal and coccyx fistulae, postoperative wounds, diabetic ulcers and burns. Doses ranging from 3 to 150 g cream were applied for 45-60 min. In all patients except three the analgesia was adequate for debridement. We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient.