Background: VAC dressing changes are frequently painful. We hypothesized that using topical lidocaine would decrease the pain during VAC dressing changes. Methods: A double blind, randomized, prospective study was performed on patients (N=65) undergoing VAC dressing changes at a single institution between 12/03 and 6/05. Patients were randomized to receive either 0.2% lidocaine or 0.9% saline administered through the VAC suction tubing into the foam dressing 30 minutes prior to each dressing change. All patients received morphine sulfate ad lib. Pain scores were assessed according to the 0-10 numeric pain distress scale method. Results: Patients receiving lidocaine experienced less pain than did control patients during and immediately after the first dressing change (p<.05). However, opioid use in the first half hour after the dressing change was greater in this group. Other measures of pain and anxiety, namely blood pressure and heart rate were similar in both groups. Conclusions: During the initial VAC dressing change, 0.2% lidocaine administered via the suction tubing led to a reduction in pain experienced by patients in our study. The impact of the lidocaine may be short lived as patients in this group requested more opiates in the period after the dressing change.