Topical Lidocaine for Wound Pain — SCE Palliative Medicine MCQ

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ModeratePain ManagementTopical Lidocaine for Wound PainSCE Palliative Medicine

A 58‑year‑old woman with advanced breast cancer has a malignant wound on her chest wall that is exquisitely painful to touch during dressing changes. Systemic opioids and topical morphine gel provide insufficient relief. What additional topical agent may help manage the dressing‑change pain?

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Correct answer: A — Topical lidocaine 1–2% gel applied 15–30 minutes before dressing change to provide local anaesthesia

Topical lidocaine (e.g. 1–2% gel) applied before dressing changes provides local anaesthesia of the wound surface, reducing procedural pain when systemic opioids and morphine gel are inadequate. UK palliative‑care prescribing guidance recommends irrigation with 1% topical lidocaine 30 minutes before dressing change ([england.nhs.uk](https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/5/2018/06/Palliative_Care_Prescribing_Guidelines_-_May_2014_Blackpool.pdf?utm_source=openai)), and Guy’s and St Thomas’ NHS Trust patient information confirms use of 2% lidocaine in Lutrol gel for malignant wounds ([guysandstthomas.nhs.uk](https://www.guysandstthomas.nhs.uk/health-information/lidocaine-lutrol-gel-pain-relief?utm_source=openai)). The other options—antibiotic, antifungal, steroid, retinoid—address infection, inflammation, or skin appearance, but do not provide anaesthesia, making them incorrect choices for procedural pain relief.

Reference: Palliative Care Prescribing Guidelines (Blackpool, 2014) – analgesia prior to dressing changes; Guy’s and St Thomas’ NHS Foundation Trust (2024) – lidocaine Lutrol gel for wound pain, https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/5/2018/06/Palliative_Care_Prescribing_Guidelines_-_May_2014_Blackpool.pdf