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