Effect of Topical Local Anesthetic Application to Skin Harvest Sites for Pain Management in Burn Patients Undergoing Skin-Grafting Procedures

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.

Transcervical intrauterine bupivacaine for the management of postoperative pain following endometrial balloon ablation—a pre-trial toxicity study

“…Intraperitoneal bupivacaine has been used in dosages between 50 and 285 mg for postoperative pain following laparoscopic procedures in general surgical and gynaecological practice and dosages of less than 100 mg were not found to be effective [7,8]. In this study, although a Foley catheter was used to occlude the cervical os, there is potential for leakage and, therefore, for the intervention to be effective, 125 mg of bupivacaine was used without titrating for body weight, making sure the maximum therapeutic dose (2 mg/kg) was not crossed in smaller women.…”

“…There are, however, a number of studies reporting on the safety and efficacy of topical local anaesthetic solutions (lignocaine and bupivacaine) when used in traumatised and inflamed tissue, for example, severe burns and spinal surgery with serum levels below the toxic range [7,8]. This has prompted us to plan a randomised controlled trial to test the postoperative analgesic efficacy of transuterine bupivacaine following second-generation endometrial ablation procedures.…”

Postoperative Pain and Other Acute Pain Syndromes

“…485 Local anesthetics, administered either topically or by local infiltration, have also been used successfully to decrease the pain associated with skin grafting. 486,487 Ketamine, a dissociative anesthetic, has the advantage of providing analgesia while maintaining stable hemodynamic function and causing minimal respiratory depression. Studies also suggest that ketamine may suppress burn-induced secondary hyperalgesia.…”

Schmerztherapie bei Verbrennungen

“…In dieser prospektiven randomisierten Studie konnten postoperativ eine signifikante Reduktion des Opioidverbrauchs und signifikant niedrigere Scores auf der visuellen Analogskala nachgewiesen werden. Jellish et al [12] untersuchten die topische Applikation von Lokalanästhetika auf Hautentnahmestellen im Rahmen von Hauttransplantationen. Hierbei kann mit topischem Lidocain (20%ige Lidocainlö-sung als Aerosol appliziert) eine analgetische Wirkung mit reduziertem Narkotikaverbrauch, verglichen mit der Anwendung von Kochsalzlösung, erzielt werden.…”