Richman Michael, Berman Jeffrey M, Ross Elizabeth M
Department of Pediatric Anesthesiology, Seattle Children's Hospital, Seattle, USA.
Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Cureus. 2021 Oct 26;13(10):e19063. doi: 10.7759/cureus.19063. eCollection 2021 Oct.
Pediatric burns are a common and often devastating injury. Treatment, reconstruction, and rehabilitation are painful experiences. For some, the experience triggers post-traumatic stress disorder and/or a chronic pain syndrome. Given the role pain plays as a major secondary disease, it must be addressed to achieve optimal healing. Regional anesthesia has been used extensively to manage postoperative pain and reduce the need for opioids following other surgical procedures in children. However, regional anesthesia is not widely used in pediatric burn care. We present a descriptive, retrospective case series of 15 pediatric burn patients who received regional anesthesia as part of their intra-operative pain management. In our patient population, we saw low levels of anesthetic as well as opioid usage with well-controlled pain. In this cohort, 93% of patients scored a 0/10 on the Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain by post-anesthesia care unit (PACU) discharge, with an average PACU stay of 70 minutes. Thirty-three percent of patients received no opioids, with the average opioid dose being 0.06mg/kg morphine equivalents. This case series serves to make clinicians aware of the feasibility of use and benefits of regional anesthesia in pediatric burn patients requiring operative repair.
小儿烧伤是一种常见且往往具有毁灭性的损伤。治疗、重建和康复过程都很痛苦。对一些人来说,这种经历会引发创伤后应激障碍和/或慢性疼痛综合征。鉴于疼痛作为一种主要的继发性疾病所起的作用,必须加以解决以实现最佳愈合。区域麻醉已被广泛用于管理小儿其他外科手术后的术后疼痛并减少阿片类药物的使用。然而,区域麻醉在小儿烧伤护理中并未得到广泛应用。我们呈现了一个描述性的回顾性病例系列,其中15例小儿烧伤患者在术中疼痛管理中接受了区域麻醉。在我们的患者群体中,我们发现麻醉剂和阿片类药物的使用水平较低,且疼痛得到了良好控制。在这个队列中,93%的患者在麻醉后护理单元(PACU)出院时,面部、腿部、活动、哭闹和安慰度(FLACC)疼痛量表上的评分为0/10,平均在PACU停留70分钟。33%的患者未使用阿片类药物,阿片类药物的平均剂量为0.06mg/kg吗啡当量。这个病例系列旨在让临床医生了解区域麻醉在需要手术修复的小儿烧伤患者中使用的可行性和益处。
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