No abstract

ObjectiveTo determine if topical administration of local anesthesia, applied to fresh skin-harvest sites, reduces pain and analgesic requirements after surgery. Summary Background DataNonopioid treatments for pain after therapeutic procedures on patients with burns have become popular because of the side effects associated with narcotics. The topical administration of local anesthesia originally offered little advantage because of poor epidermal penetration. MethodsThis study compares 2% lidocaine with 0.5% bupivacaine or saline, topically applied after skin harvest, to determine what effect this may have on pain and narcotic use. Sixty patients with partial-or full-thickness burns to approximately 10% to 15% of their body were randomly divided into three groups: group 1 received normal saline, group 2 had 0.5% bupivacaine, and group 3 had 2% lidocaine sprayed onto areas immediately after skin harvest. Blood samples were subsequently obtained to measure concentrations of the local anesthetic. Hemodynamic variables after surgery, wake-up times, emetic symptoms, pain, and narcotic use were compared. ResultsHigher heart rates were noted in the placebo group than in those receiving lidocaine or bupivacaine. No differences were noted in recovery from anesthesia or emetic symptoms. Pain scores were lower and 24-hour narcotic use was less in patients who received lidocaine. Plasma lidocaine levels were greater than bupivacaine at all time points measured. ConclusionsTopical lidocaine applied to skin-harvest sites produced an analgesic effect that reduced narcotic requirements compared with patients who received bupivacaine or placebo. Local anesthetic solutions aerosolized onto skin-harvest sites did not affect healing or produce toxic blood concentrations.One of the major problems faced by patients during recovery from burn injury is the pain of repeated therapeutic procedures.1 Pain from skin debridement and grafting procedures may be an important factor in the development of psychiatric disorders and depression, especially if control of pain is inadequate. The perception of pain from a given stimulus is influenced by numerous factors, including patient variability, ethnic background, socioeconomic class, previous life experiences, and support systems.2 About 52% of patients report pain during burn wound debridements, whereas 84% describe extreme pain after therapeutic procedures.2 The size and depth of the burn injury may also influence the amount of perceived pain.Opioid administration is the dominant form of analgesic therapy in this patient population.2 The pharmacokinetics of opioids are altered in patients with burn injury, both immediately after the event and for weeks to come because of changes in the volume of distribution, unbound drug fraction, clearance half-life, and sensitivity. In addition, opioid requirements may increase over time, may reach a ceiling effect, and may not be able to provide complete analgesia in 115Address reprint requests to W.

We compared four different analgesics in the management of pain after placement of pressure equalization tubes during myringotomy in children and demonstrated that ketorolac or butorphanol provided superior analgesia when compared with acetaminophen with codeine or plain acetaminophen. Children who received ketorolac versus butorphanol had less vomiting in the 24 h after surgery.

To determine whether perioperative administration of ropivacaine hydrochloride with epinephrine decreases postoperative pain following adenotonsillectomy and to determine the pharmacokinetics of ropivacaine following injection.

Spinal anesthesia with supplemental epidural clonidine in combination with incision site subcutaneous bupivacaine was evaluated both intra- and postoperatively and compared with spinal anesthesia alone for lower lumbar spine procedures. Both epidural clonidine and subcutaneous incisional bupivacaine, added to spinal anesthesia for lumbar spine surgery, improves pain relief and reduces the need for postoperative opioids with their associated side effects.