Pain perception and management during chemical debridement with a topical desiccating agent: a case-series analysis

A new topical desiccating agent (TDA; DEBRICHEM, DEBx Medical BV, the Netherlands) based on methanesulfonic acid (MSA) and dimethyl sulfoxide (DMSO) has proved to be an effective biofilm- and necrosis-removing chemical debridement option. However, its application can be temporarily accompanied by sharp pain perception, depending on the individual patient. This study aimed to assess application-associated pain and two strategies to manage this.

A single-centre, retrospective, case-series study design was used to assess pain associated with MSA/DMSO treatment. To lower pain sensation during the application, two different local anaesthetic procedures were applied using either an anaesthetic cream or a form of tumescent local anaesthesia (TLA). Pain was assessed using the visual analogue scale (VAS) before, during and at five minutes after treatment. Overall wound pain, pain during dressing change in general and during the last change, as well as during the last sharp debridement were assessed. Additionally, baseline pain medication, medication during treatment and local anaesthetic management before MSA/DMSO application were recorded. Patients with peripheral neuropathy were excluded from the analyses.

A total of 20 patients treated with TDA were identified. Application lasted 20 minutes before treatment. Chemical debridement was associated with individual pain during application (VAS range 0-10). However, using adequate management, pain could be effectively reduced with no significant difference between pain ratings for TDA and the usually applied sharp debridement.

Accompanying pain during (chemical) TDA debridement was well managed using ready-to-use anaesthetic approaches. It demonstrated no increased overall pain perception compared with sharp debridement and, in some individual cases, even lower pain ratings.