Ultrasound-Guided Axillary Brachial Plexus Block for the Management of Graft Site Pain During Dressing Change in the Burn-Injured Patient: A Randomized Control Trial.

Burn injuries requiring split-thickness skin grafting procedures often require ongoing wound aggravation in the form of dressing changes. These dressing changes may cause significant pain due to stimulation of damaged nerve endings in the epidermal layer. A randomized control trial, pilot study, was undertaken to evaluate the impact of ultrasound-guided regional nerve block on the outcome of patient reported pain scores by inpatients requiring dressing changes for hand and upper limb burn injuries. Twenty participants aged >18 years, requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit between August 2018 and September 2020. Participants were randomized to control (10 participants) or intervention group (10 participants). All participants received analgesia as per their treating team, the intervention group received the addition of an ultrasound-guided axillary brachial plexus block prior to their dressing change procedure. The primary outcome was to assess perceived pain at the graft site as measured by the Numeric Pain Rating Scale (0-10) before, during, and after dressing change procedure. There was strong evidence of a difference in the adjusted mean change score between groups, with a mean reduction of 4.3 in the intervention group, indicating reduced pain, and a mean increase of 1.2 in the control group (P < .001). No adverse events occurred in either group, and the addition of ultrasound-guided regional anesthesia (RA) for the treatment of dressing pain was determined to be a safe and effective intervention.

Ultrasound-Guided Fascia Iliaca Plane Block for the Treatment of Donor Site Pain in the Burn-Injured Patient: A Randomized Control Trial.

Burn injuries requiring surgical intervention often result in split-thickness skin grafting procedures, with donor skin frequently harvested from the patient's anterolateral thigh. The donor site is often reported as the primary site of postoperative pain due to the damage sustained to localized nociceptors. A randomized control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient-reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomized to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0-10). During the postoperative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range [IQR] 0-0), compared to the control group median 6 (IQR 4-7) (P < .001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0-4) compared to control group median 4.5 (IQR 2-6) (P = .043). The study findings demonstrated that regional anesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.

Exploring the Role of Regional Anesthesia in the Treatment of the Burn-injured Patient: A Narrative Review of Current Literature.

OBJECTIVES: The review article was designed to assess the effectiveness of regional anesthesia (RA), specifically peripheral nerve blocks, in the treatment of burn pain; with noting of clinical indications and contraindications for peripheral nerve block application, along with discussion of evidence-based analgesic strategies for providing improved, comprehensive burn pain management. MATERIALS AND METHODS: A search of relevant literature was performed using CINAHL, PubMed, EMBASE, Web of Science, and SCOPUS with a publication date between January 2005 and December 2017. RESULTS: The search yielded 10 results that met criteria. Two randomized control trials were included, though they focused on analgesia for donor-site pain only, 1 clinical trial, 2 case series, 2 retrospective audit, 1 burn protocol, and 2 review articles. DISCUSSION: RA techniques are an adjunct therapy currently used worldwide to improve patient pain outcomes and reduce the adverse effects associated with general anesthetic. RA presents a safe and effective intervention for acute pain resulting from burn-acquired injury. This review of current literature supports the use of RA as a treatment to manage pain associated with burn-related care procedures as an addition to multimodal pain treatment. To date there is limited evidence showing the use of RA in the burns' patient population. In addition, there appear to be no particular risks to using the technique of RA in this group. Further prospective studies are required to provide information about the benefits and limitations of RA.