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

Pain:

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

Odor:

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

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

Odor-control dressings