Goals are to control symptoms (pain, odor) manage infection, exudate and preserve dignity. Involve wound care nurse. Debride necrotic tissue to aid in healing, odor and absorption of opioid for pain.
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
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939111/pdf/0560883.pdf
For dressing change pain: see Incident pain
Odor:
Flagyl powder sprinkled over the wound (after the topical opioid). Topical flagyl gel (1%) if using morphine in gel.
Put odor-control cat litter on tray under patient’s bed, essential oils (peppermint, vanilla, etc…) used to mask odor (ensure scent is acceptable to patient
Odor-control dressings