Sinha Sarthak, Schreiner Amanda J, Biernaskie Jeff, Nickerson Duncan, Gabriel Vincent A
From the Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Pediatrics and Surgery, Faculty of Medicine (S.S., V.A.G.) Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine (S.S., J.B.), Faculty of Medicine (A.J.S., V.A.G.), University of Calgary, Alberta, Canada; Calgary Firefighters' Burn Treatment Centre (D.N., V.A.G.); and Section of Plastic Surgery, Department of Surgery (D.N.), University of Calgary, Alberta, Canada.
J Trauma Acute Care Surg. 2017 Nov;83(5):954-964. doi: 10.1097/TA.0000000000001615.
Split-thickness skin grafting is the most common reconstructive procedure in managing burn injuries. Harvesting split-thickness skin creates a new partial thickness wound referred to as the donor site. Pain at the donor site is reported to be one of the most distressing symptoms during the early postoperative period. Here, we (a) identify strategies for managing donor site pain, (b) assess the quality of individual studies, and (c) formulate evidence-based recommendations based on the amount and consistency of evidence. Our analysis revealed five distinct approaches to minimize donor site pain. These include: continuous subcutaneous local anesthetic infusion (three studies), subcutaneous anesthetic injection (five studies), topical agents (six studies), nonpharmacological interventions (three studies), and wound dressings (18 studies). Available randomized control trials typically evaluated pain on standardized scales (i.e. Visual Analog Scale, Numerical Rating Scale), and compared the experimental group with standard care. Recommended treatments include: (a) subcutaneous anesthetic injection of adrenaline-lidocaine; (b) ice application; (c) topical agents, such as lidocaine and bupivacaine; and (d) hydrocolloid- and polyurethane-based wound dressings accompanied with fibrin sealant. Methodologically sound randomized control trials examining the efficacy of modified tumescent solution, ropivacaine, plasma therapy, noncontact ultrasound, and morphine gels are lacking and should be a priority for future research.
分层皮片移植是治疗烧伤最常见的重建手术。取分层皮片会形成一个新的部分厚度伤口，称为供皮区。据报道，供皮区疼痛是术后早期最令人痛苦的症状之一。在此，我们（a）确定管理供皮区疼痛的策略，（b）评估个体研究的质量，以及（c）根据证据的数量和一致性制定基于证据的建议。我们的分析揭示了五种不同的减轻供皮区疼痛的方法。这些方法包括：持续皮下局部麻醉剂输注（三项研究）、皮下麻醉剂注射（五项研究）、局部用药（六项研究）、非药物干预（三项研究）和伤口敷料（18项研究）。现有的随机对照试验通常使用标准化量表（即视觉模拟量表、数字评定量表）评估疼痛，并将实验组与标准护理进行比较。推荐的治疗方法包括：（a）皮下注射肾上腺素-利多卡因；（b）冰敷；（c）局部用药，如利多卡因和布比卡因；以及（d）使用水胶体和聚氨酯基伤口敷料并辅以纤维蛋白密封剂。缺乏对改良肿胀液、罗哌卡因、血浆疗法、非接触式超声和吗啡凝胶疗效进行方法学上合理的随机对照试验，这些应成为未来研究的重点。
