Document Detail

Use of Continuous Local Anesthetic Infusion in the Management of Postoperative Split-Thickness Skin Grafts Donor Site Pain.
MedLine Citation:
PMID:  23271060     Owner:  NLM     Status:  Publisher    
Donor sites from split-thickness skin grafts (STSG) impose significant pain on patients in the early postoperative period. We report the use of continuous local anesthetic infusion as a method for the management of postoperative STSG donor site pain. Patients undergoing single or dual, adjacent STSG harvest from the thigh (eight patients) or back (one patient) were included in this study. Immediately after STSG harvest, subcutaneous catheters were placed for continuous infusion of local anesthetic. Daily donor site-specific pain severity scores were prospectively recorded in nine patients receiving local anesthetic infusion. Patient characteristics, technical aspects, and postoperative complications were identified in the study. The thigh was the anatomic location chosen for most donor sites. A single catheter was placed for donor sites limited to 4 inches in width or less. A dual catheter system was used for those wider than 4 inches. An elastomeric pump delivered continuously a total of 4 ml/hr of a solution of 0.5% bupivacaine. The average anesthetic infusion duration was 3.1 days. A substantial decrease in worst, least, and average donor site pain scores was found from the first 24 hours to the second postoperative day in our patients, a treatment trend that continued through postoperative day 3. One patient developed minor anesthetic leakage from the catheter insertion site; and in three cases, accidental dislodgement of the catheters occurred. There were no cases of donor site secondary infection. All donor sites were completely epithelialized at 1-month follow-up. Continuous local anesthetic infusion is technically feasible and may represent an option for postoperative donor site pain control after STSG harvesting. Relative cost-benefit of the technique remains to be determined.
Jorge L Reguero Hernandez; Alisa Savetamal; Roselle E Crombie; Walter Cholewczynski; Nabil Atweh; Paul Possenti; John T Schulz
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-24
Journal Detail:
Title:  Journal of burn care & research : official publication of the American Burn Association     Volume:  -     ISSN:  1559-0488     ISO Abbreviation:  J Burn Care Res     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262774     Medline TA:  J Burn Care Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Brideport Hospital, Yale-New Haven Surgery Residency Program, Connecticut.
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