Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan.
J Plast Surg Hand Surg. 2023 Aug 1;58. doi: 10.2340/jphs.v58.12292.
Opioids provide good analgesic effect in burn patients during acute phase, but these patients may develop tolerance after prolonged exposure. Alternative analgesic strategies such as peripheral nerve blocks appear to provide adequate pain control while sparing opioid-related side effects. The purpose of this study was to evaluate intravenous patient-controlled analgesia (IV-PCA) and continuous peripheral nerve block (CPNB-PCA) in severe burn patients with relatively young age undergoing repeated debridement and large-area full thickness skin graft (FTSG).
The records of victims in dust explosion in Taiwan in 2016 from Chang Gung Memorial Hospital Pain Service Database between 2016 June and 2017 December were evaluated. The patients' demographic data including age, gender, weight, burn area, degree of burn, type of PCA regimen (IV-PCA versus CPNB-PCA), size of FTSG, and adverse effects were collected.
The total in-hospital morphine consumption was significantly lower in CPNB-PCA than IV-PCA group. A trend of decrease in numerical rating scores (NRS) was observed for both groups and CPNB group had comparable NRS than IV-PCA group at rest. On movement, CPNB grouped had significantly lower NRS than IV-PCA on post-operative day 3.
Our study demonstrated that in patients requiring high dosage of opioid, CPNB may be a suitable alternative for pain control.
阿片类药物在烧伤患者急性期提供良好的镇痛效果，但这些患者在长时间暴露后可能会产生耐受性。替代镇痛策略，如外周神经阻滞，似乎可以提供足够的疼痛控制，同时避免阿片类药物相关的副作用。本研究的目的是评估静脉患者自控镇痛（IV-PCA）和连续外周神经阻滞（CPNB-PCA）在接受反复清创和大面积全厚皮片移植（FTSG）的年轻严重烧伤患者中的效果。
评估台湾长庚纪念医院疼痛服务数据库中 2016 年 6 月至 2017 年 12 月间 2016 年尘爆事件中受害者的记录。收集患者的人口统计学数据，包括年龄、性别、体重、烧伤面积、烧伤程度、PCA 方案类型（IV-PCA 与 CPNB-PCA）、FTSG 大小和不良反应。
CPNB-PCA 组的总住院吗啡消耗量明显低于 IV-PCA 组。两组的数字评分（NRS）均呈下降趋势，CPNB 组在休息时的 NRS 与 IV-PCA 组相当。在运动时，CPNB 组在术后第 3 天的 NRS 明显低于 IV-PCA 组。
我们的研究表明，对于需要高剂量阿片类药物的患者，CPNB 可能是一种合适的替代镇痛方法。
