McBride Craig A, Wong Marilyn, Patel Bhaveshkumar
Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia.
Burns Trauma. 2022 Sep 19;10:tkac020. doi: 10.1093/burnst/tkac020. eCollection 2022.
Topical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use.
Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented.
There were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels.
Topical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.
局部外用镇痛和麻醉剂已用于取皮后即刻及分层皮片移植（STSG）供皮区伤口（DSW）术前。对于其在取皮后镇痛方面的有效性以及全身吸收可能产生的毒性作用，尚无系统评价。本研究旨在探讨哪种药物（若有）比其他药物更具优势，以及关于其使用是否有任何安全性数据。
对应用于STSG DSWs的外用药物进行随机对照试验的系统文献综述，以提供镇痛效果。通过检索Cochrane和EBSCO数据库确定研究。对语言和发表年份无限制。主要结局：（清醒状态下）取STSG时的疼痛以及取皮后疼痛（直至首次换药）。次要结局是相对于已发表的中毒剂量数据的血清药物水平。在评估纳入研究时使用Cochrane偏倚风险评估工具。至少两名审阅者筛选并评审纳入研究。呈现叙述性综述。
有11项研究符合纳入标准。总体方法学质量和患者数量较少。术前局部应用利多卡因和丙胺卡因的 eutectic 混合物在清醒状态下取STSG时可提供良好的局部麻醉。局部应用布比卡因（5项研究）或利多卡因（1项研究）在取皮后提供的麻醉/镇痛效果明显优于安慰剂。局部应用吗啡的效果不比安慰剂好。报告剂量下的局部外用麻醉剂均远低于中毒血清水平。
局部外用麻醉剂（利多卡因或布比卡因）在STSG取皮期间及之后均能提供良好的镇痛效果，且远低于中毒血清水平，但尚无确定最佳局部麻醉剂的良好数据。没有证据表明吗啡的效果优于安慰剂。
