Wound Care

Goals are to control symptoms (pain, odor) manage infection, exudate and preserve dignity


may be constant or incident with dressing change or movement

systemic opioids may not control pain adequately

opioid receptors present on open wounds and fungating tumors

Topical Opioids:

Methadone powder 100mg in 10g of inert wound powder (1% concentration)

Use 2.5g of mix per 15cm2 (3inch2) of surface area (aprox.)

Apply as last step prior to dressing

Shake on wound or tumor – completely cover open tissue with a thick layer of powder

Ensure undermined tissue surface is covered with mix

If pain relieved, patient drowsy – reduce systemic opioid

May use morphine in hydrophilic gel at 1% concentration if methadone unavailable

For dressing change pain: see Incident pain


Flagyl powder sprinkled over the wound (after the topical opioid)

Put odor-control cat litter on tray under patient’s bed

Odor-control dressings