Edkins Renee E, Hultman C Scott, Collins Paul, Cairns Bruce, Hanson Marilyn, Carman Margaret
From the *Division of Plastic Surgery, †NC Jaycee Burn Center, and ‡Department of Anesthesia, University of North Carolina Health Care System, Chapel Hill, NC; and §Duke University School of Nursing, Durham, NC.
Ann Plast Surg. 2015 Mar;74(3):293-9. doi: 10.1097/SAP.0000000000000367.
Utilization of fractionated ablation with a carbon dioxide (CO2) laser has shown to be efficacious in the management of symptomatic burn scars. Although effective, this procedure is painful and burn patients traditionally evidence low pain tolerance. For this reason intravenous anesthesia is used during these procedures. However, operative anesthetics and intravenous opioids are associated with patient discomfort postoperatively and prolonged recovery times. The American Society of Anesthesiologists' (ASA) Task Force on Acute Pain Management for the perioperative setting recommends the use of multimodal anesthesia, including the use of regional blockade with a local anesthetic. A quality improvement project was implemented to incorporate this practice and evaluate outcomes. The main goal of this project was to improve patient comfort as evidenced by improved pain scores with a decreased requirement for intravenous opioids post-procedure. The secondary goal of this project was to improve patient throughput in the setting of an outpatient surgical facility as evidenced by decreased time in the facility.
A historic cohort of 36 cases was compared to 36 cases managed under the ASA guidelines for multimodal anesthesia utilizing a topical local anesthetic. Statistical analysis included a t-test for continuous variables while chi square was utilized to analysis dichotomous variables.
Intravenous narcotic utilization and mean pain scores in the recovery phase of care were significantly reduced as a result of adoption of the ASA recommendations. Throughput time increased by 36 minutes; notably in the preoperative phase, while patient movement through the procedural phase was significantly decreased as was procedure to discharge times.
Implementing the use of a topical anesthetic as a component of multimodal anesthesia for patients undergoing fractionated laser ablation of symptomatic burn scars can significantly decrease patient pain and the need for intravenous opioids during the recovery phase of care. Increased overall throughput times were noted primarily in the preoperative period, while procedure to discharge times decreased. As operative and recovery phases represent higher operational costs, decreased time in these areas represent potential cost savings for the facility.
使用二氧化碳（CO2）激光进行分次消融已被证明在治疗有症状的烧伤疤痕方面是有效的。尽管有效，但该手术很痛苦，而且烧伤患者传统上显示出较低的疼痛耐受性。因此，在这些手术过程中会使用静脉麻醉。然而，手术麻醉剂和静脉注射阿片类药物会导致患者术后不适以及恢复时间延长。美国麻醉医师协会（ASA）围手术期急性疼痛管理特别工作组建议使用多模式麻醉，包括使用局部麻醉剂进行区域阻滞。实施了一项质量改进项目以纳入这种做法并评估结果。该项目的主要目标是提高患者舒适度，表现为术后疼痛评分改善以及静脉注射阿片类药物的需求减少。该项目的次要目标是提高门诊手术设施环境下的患者周转率，表现为在该设施内的时间减少。
将36例历史队列病例与按照ASA多模式麻醉指南使用局部局部麻醉剂管理的36例病例进行比较。统计分析包括对连续变量进行t检验，同时使用卡方分析二分变量。
由于采用了ASA建议，护理恢复阶段的静脉麻醉剂使用和平均疼痛评分显著降低。周转时间增加了36分钟；特别是在术前阶段，而患者在手术阶段的移动显著减少，手术至出院时间也显著减少。
对于接受有症状烧伤疤痕分次激光消融的患者，实施使用局部麻醉剂作为多模式麻醉的一部分，可以在护理恢复阶段显著减轻患者疼痛并减少对静脉注射阿片类药物的需求。总体周转时间增加主要出现在术前阶段，而手术至出院时间减少。由于手术和恢复阶段代表更高的运营成本，这些区域时间的减少意味着该设施可能节省成本。
