Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States.
Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States.
Burns. 2022 Aug;48(5):1166-1171. doi: 10.1016/j.burns.2021.08.025. Epub 2021 Sep 4.
Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures.
This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed.
In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant.
In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
在烧伤患者中，经常会出现供皮区术后疼痛处理不足的情况，这可能会影响重建效果，并导致有害的心理后果。我们发现迫切需要探索和推广非阿片类、多模式的镇痛药物。在青少年和年轻成年烧伤患者中，尚未有研究报道局部麻醉药脂质体布比卡因对供皮区的浸润作用。因此，本研究的目的是评估术中脂质体布比卡因浸润对接受重建性皮肤移植手术的青少年和年轻成年烧伤患者供皮区疼痛的控制效果。
本回顾性分析纳入了年龄在 14-25 岁之间、至少接受过两次重建性皮肤移植手术的患者，其中一次接受标准治疗（盐酸布比卡因）供皮区浸润，另一次接受脂质体布比卡因供皮区浸润。最终样本包括 30 例患者，共 44 例脂质体布比卡因病例和 53 例标准治疗病例进行分析。
在作者的五年经验中，与标准治疗相比，使用脂质体布比卡因与术后 0-4 小时疼痛评分（平均 1.4/10 与 2.3/10，p = 0.04）和术后 0-24 小时疼痛评分（平均 1.7/10 与 2.4/10，p = 0.02）显著降低相关。两种镇痛药物均未出现不良反应。住院时间和术后阿片类药物使用量的差异不认为具有统计学意义。
在这项回顾性分析中，作者报告了第一个结果，表明术中脂质体布比卡因供皮区浸润可能与青少年和年轻成年烧伤患者的统计学改善的患者结局相关。然而，报告的差异可能在临床上并不显著，这就需要进一步评估在这一独特的患者群体中使用脂质体布比卡因的必要性。
