Incision and drainage procedures on methicillin-resistantStaphylococcus aureus wounds can be painful. Lidocaine does not seem to work very well.What other numbing agents are available?– Alyce Huntsinger, FNP, NNP, Portland, Ore.

Incision and drainage on already infected skin structures will always be uncomfortable for the patient. The infection most likely has created inflammation and pressure on surrounding skin, structures, and nerves. Most importantly, all local anesthetics will function poorly in the acidic environment of an acutely infected abscess, no matter what the infective organism is.

I recommend lidocaine with epinephrine for all site-appropriate structures and patients whenever possible. The epinephrine will help control bleeding and further numb the area. Another advantage to using epinephrine is that the patient will be numb for longer post procedure. Bupivacaine 0.25% (Marcaine) with epinephrine is another option.

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Make sure you place the local anesthesia and let the patient sit for at least 20 minutes before starting the procedure. This allows the anesthesia to take effect and will help decrease the patient’s discomfort.

I also believe in the power of distraction. Have staff or a family member talk to the patient about anything other than the procedure or pain. Providing rubber balls that the patient can squeeze during the procedure may be helpful as well. Finally, some clinicians believe that stimulating adjacent tissue with movement alleviates pain. — Abby A. Jacobson, PA-C (188-4)

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