Objective: Debridement is the removal of nonviable, contaminated, or foreign material from within or near a wound until healthy adjacent tissue is exposed. In sharp debridement, patients are expected to experience greater levels of pain because of cell damage. This study evaluated the effect of applying cold 0.9% sodium chloride (NaCl) during sharp debridement on pain in patients with diabetic foot.
Method: A randomised, controlled, single-blind trial was performed with inpatients randomised to two equally sized groups: an experimental group and a control group. During sharp debridement, cold (4-8°C) 0.9% NaCl was applied to the wounds in the experimental group while room temperature (18-26°C) 0.9% NaCl was used in the control group. Data were collected using a questionnaire form, a visual analogue scale (VAS) and a wound area form. The VAS was applied in both groups before and during the procedure. Descriptive statistics and Chi-squared, Mann-Whitney U, Student's t and Wilcoxon signed-rank tests were used to analyse the data.
Results: A total of 64 patients were included in the trial (32 in each group). Most of the participants in the experimental and control groups were male (84.4% and 65.6%, respectively) and the mean age was 61.8 years and 60.6 years, respectively. The participants were homogeneously distributed in terms of sociodemographic, clinical, laboratory and wound characteristics, with no statistically significant differences between the groups (p>0.05). Compared to pre-procedure values, VAS score decreased significantly during the procedure in the experimental group (p<0.001) but increased significantly in the control group (p<0.001). VAS scores in the experimental group were significantly higher before (p=0.003) and lower during (p<0.001) the procedure compared with the control group.
Conclusion: In this trial, applying cold 0.9% NaCl during sharp debridement reduced pain in patients with diabetic foot.
Keywords: cold application; diabetic foot; procedural pain; sharp debridement; wound; wound care; wound dressing; wound healing.