An alternative to opioid-based intravenous patient controlled analgesia in severe burn patients undergoing full thickness split graft in upper limbs

Bo-Fu  Shih; Fu-Yu Huang; Shih-Jyun Shen; Chih-Wen Zheng; Chao-Wei Lee; Ming-Wen Yang; An-Hsun Chou; Shiow-Shuh Chuang; Hsin-I Tsai

doi:10.2340/jphs.v58.12292

Authors

Bo-Fu Shih Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
Fu-Yu Huang Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
Shih-Jyun Shen Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
Chih-Wen Zheng Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
Chao-Wei Lee College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
Ming-Wen Yang Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
An-Hsun Chou Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Shiow-Shuh Chuang College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Plastic Surgery, Burn Unit, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
Hsin-I Tsai Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan

DOI:

https://doi.org/10.2340/jphs.v58.12292

Keywords:

Continuous peripheral nerve block, Patient controlled analgesia, Full thickness split graft, Burn

Abstract

Background: 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).
Methods: 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.
Results: 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.
Conclusion: Our study demonstrated that in patients requiring high dosage of opioid, CPNB may be a suitable alternative for pain control.

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