Definition & Overview
A dressing change under anaesthesia is a routine medical procedure used to change the dressing of wounds. There are several reasons why fresh and sterile dressings are necessary in managing wounds. Aside from protecting the wound from infection, sterile dressings also help promote healing as well as reduce the risk of bleeding and scarring.
Due to the risk of bacterial infection, it is important for dressings to be changed regularly. This means that the patient has to repeatedly undergo the procedure, which can cause a lot of pain especially if the wound is severe. For this reason, dressing changes are sometimes performed under anaesthesia.
Who Should Undergo and Expected Results
A dressing change under anaesthesia is performed on patients who suffer from:
- Large open wounds
- Severe burn wounds
- Recent or fresh wounds
- Paediatric wounds
While small wounds can be dressed without pain, more severe wounds can cause excruciating pain every time their dressing is changed. This is because pain-sensing nerves are also in the process of regeneration when the wound is healing, making wounds and the area around them especially sensitive. And since the dressings come in direct contact with the wound surface, even just removing an old dressing can be quite painful.
Studies show that a lot of patients who suffer from major wounds experience post-traumatic stress disorder, which is partly due to the repetitive bouts of pain that they experience during dressing changes. Since the procedure is painful, some patients end up dreading or even avoiding dressing changes.
In an effort to make the process painless and comfortable, doctors eliminate one of the major hindrances to successful wound management with the use of anaesthesia. This encourages patients to have their dressings changed regularly or as frequently as needed. For this reason, anaesthetics have become an important part of the wound management process.
How is the Procedure Performed?
The type of anaesthesia used during a dressing change depends on the wound’s size, severity, and location.
For small wounds, the dressing can be changed painlessly under conscious sedation or a mild form of anaesthesia. Patients are kept awake and fully conscious during the procedure.
On the other hand, for larger wounds like widespread third-degree burn wounds, the patient may need to be placed under general anaesthesia.
Once the anaesthesia is in effect, the physician begins the procedure by removing the patient’s old wound dressings. With the wound exposed, the physician then performs a routine check to look for signs of infection or other potential problems. Telltale signs of an infected wound include:
- Pus discharge
Before changing the dressing, the physician also cleanses the wound and applies medication, if necessary. A new sterile dressing is then placed over the entire wound surface. The sterile dressing is then secured in place with adhesives.
Doctors use several different types of dressings to care for patients’ wounds. Some are synthetically made, while some are biocompatible. The type of dressing used depends on the type and size of the patient’s wound. It also determines how often the dressing should be changed.
Some examples of wound dressing materials include:
- Dry dressings – These are gauze pads held in place by tape or bandages. They are the most widely used dressings and are ideal for smaller wounds .
- Foam dressings – These dressings have built-in foam pads that provide additional protection to the entire wound area. Most of them also have built-in adhesives and can stick to the skin surface without the use of tape .
- Hydrofibre dressings – These are made of carboxymethylcellulose. They are ideal for pressure ulcers .
Alginate dressings – These are made of calcium, sodium salts, or seaweeds. They help maintain a moist wound environment and thus help establish hemostasis. They are good for donor sites, ulcers, and bleeding wounds.
Hydrogel dressings – These dressings stimulate the body’s natural ability to remove necrotic tissue. They are therefore ideal for wounds that show signs of infection and necrosis.
Hydrocolloid dressings – These dressings are highly effective in preventing anaerobic bacterial infections because they can effectively keep oxygen out. Thus, they are ideal for wounds that require a moist environment. Although these dressings can stay in place for up to 7 days, they need to be changed once they become saturated.
In general, however, dressings have to be changed more often if there is fluid discharge from the wound.
Possible Risks and Complications
Patients are allowed to go home after having their dressing changed. However, since the procedure is performed under anaesthesia, they are advised to avoid certain activities, such as driving or using machines. This is because anaesthesia can cause some symptoms, such as:
Anaesthesia also puts patients at risk of:
- Allergic reaction
- Anaphylaxis, or severe allergic reactions
- Cardiac arrest
Due to the risks of anaesthesia, doctors may ask patients to stay in the hospital until the effects of anaesthetic wear off. This is to help ensure their safety.
Latarjet J. “The management of pain associated with dressing changes in patients with burns.” 2002 Nov. http://www.worldwidewounds.com/2002/november/Latarjet/Burn-Pain-At-Dressing-Changes.html
Tarantino DP. “Burn pain and dressing changes.” Techniques in Regional Anesthesia and Pain Management. 2002 Jan. 6(1): 33-38. http://www.techreganesth.org/article/S1084-208X(02)50015-X/abstract