LOCAL ANESTHETICS
Brief History. A.T. is a 61-year-old woman with a history of chronic obstructive pulmonary disease. Her respiratory condition is managed pharmacologically by inhaling a combination of a longacting bronchodilator (salmeterol) and an antiinfl ammatory steroid (fl uticasone). She is also being seen in her home by a physical therapist to improve respiratory function, reduce fatigue, and increase functional ability. She recently developed a painful, blistering rash over her lateral thorax that was diagnosed as herpes zoster (shingles). A.T. had chickenpox as a child, and this episode of shingles was attributed to a fl are-up of the varicella zoster virus that remained in her body. The rash gradually diminished, but she continued to experience sharp, stabbing pain due to post-herpetic neuralgia. She consulted her physician, who prescribed a Lidoderm patch containing 5 percent lidocaine. This patch was applied to the skin over the painful area. Problem/Infl uence of Medication. A.T. asked the therapist if she could also apply a heating pad over the painful area to help provide analgesia. She had been leaving the patch on continuously and only taking the old patch off when it was time to apply a new one.
1. What should the therapist tell this patient about applying heat over the lidocaine patch?
2. What are the typical recommendations for applying and changing the patch?
