Berwick D, Young L, Lee A, Lancaster D, Dheansa B
Burns and Plastic Surgery Department, Queen Victoria Hospital NHS Trust, East Grinstead, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Ann Burns Fire Disasters. 2023 Mar 31;36(1):74-78. eCollection 2023 Mar.
Enzymatic debridement (ED) is increasingly used for cutaneous burns. Compared with surgical debridement, ED has better preservation of viable dermis, less blood loss and autografting, however ED is painful. Current recommendations suggest local anaesthesia (LA) is useful for minor burns, but the evidence base is minimal. In our centre, we routinely use LA with good analgesic effect. This study was a single-centre, prospective analysis conducted at the Queen Victoria Hospital (UK). Patients had at least superficial partial thickness burns and received subcutaneous LA prior to ED during a 1-year period (October 2019-September 2020). Pain was assessed using a numeric scale of 1-10, recorded before, during and after the procedure. In total, 27 patients were included (n=17 males) with a median age of 47 (18-88 years). The mean total burn surface area was 1.5% (0.3-5.0). Treated sites included head and neck (1), trunk (5), upper limb (9) and lower limb (16). The most used LAwas bupivacaine 0.25% (n=25), followed by lidocaine 1% (n=2). Some required additional oral analgesia (n=8) or a regional blockade (n=2). Average pain score during debridement was 1.9 We have found LA effective, with favourable pain scores in comparison to previous studies with oral analgesia or regional blockade. LA is quick and easy to perform, as opposed to nerve blocks, which require trained personnel with ultrasound guidance. LA is a useful analgesic for patients with minor cutaneous burns undergoing ED. In some cases, it is sufficient without additional oral analgesia or regional blockade.
酶促清创术（ED）在皮肤烧伤治疗中的应用日益广泛。与手术清创相比，ED能更好地保留存活的真皮组织，减少失血和自体植皮，但会引起疼痛。目前的建议表明，局部麻醉（LA）对轻度烧伤有效，但相关证据基础薄弱。在我们中心，我们常规使用LA，镇痛效果良好。本研究是在英国维多利亚女王医院进行的一项单中心前瞻性分析。在1年期间（2019年10月至2020年9月），患者至少有浅Ⅱ度烧伤，并在ED前接受了皮下LA。使用1-10数字评分法评估疼痛，在操作前、操作期间和操作后记录。总共纳入了27例患者（17例男性），中位年龄为47岁（18-88岁）。平均总烧伤面积为1.5%（0.3-5.0）。治疗部位包括头颈部（1例）、躯干（5例）、上肢（9例）和下肢（16例）。最常用的LA是0.25%布比卡因（25例），其次是1%利多卡因（2例）。一些患者需要额外的口服镇痛药（8例）或区域阻滞（2例）。清创期间的平均疼痛评分为1.9。我们发现LA有效，与之前使用口服镇痛药或区域阻滞的研究相比，疼痛评分更有利。与需要在超声引导下由训练有素的人员进行的神经阻滞不同，LA操作快速简便。对于接受ED的轻度皮肤烧伤患者，LA是一种有用的镇痛药。在某些情况下，无需额外的口服镇痛药或区域阻滞就足够了。
