Split thickness skin grafts (STSG) are commonly required in reconstructive surgery but may cause significant pain. The goal of this investigator-initiated trial is to evaluate the effect of liposomal bupivacaine on donor site pain and opioid consumption. A parallel, randomized, controlled trial of adult acute burn patients with <20% total body surface area burns (TBSA) was conducted to evaluate the efficacy of liposomal bupivacaine at STSG donor sites. The control group received standard subcutaneous infiltration of dilute lidocaine solution at the STSG donor site, and the experimental group received dilute liposomal bupivacaine infiltration in a similar fashion. Donor site pain scores and opioid consumption in morphine equivalents (MEE) were evaluated.
A total of 25 patients were enrolled in each group. There were no statistical differences in demographic variables, and TBSA was 4.0% in both groups (p=.94). There were no statistical differences in pain scores at any time point postoperatively (mean control range 3.1/10-4.9/10, experimental range 3.3/10-4.3/10, p=.12-.96). There were no statistical differences in opioid consumption at 24, 48, or 72 hours postoperatively between the groups (mean control MEE range 49.3-71.1, experimental MEE range 63.6-75.8, p=.34-.85). The average length of stay was 7.7 days in both groups (p=.88). No adverse events occurred in either group. There is no statistical benefit to the use of liposomal bupivacaine for infiltration at STSG donor sites compared to standard of care with respect to pain control, opioid use, or length of stay when evaluated in a randomized, controlled fashion.
Heterogeneity amongst selected studies is explained by variability in how complications are defined. The Pittsburgh Body Contouring Complication Reporting System provides suggested recommendations on complication reporting in massive weight loss body contouring surgery.
Hand Surgery, the American Society of Plastic Surgeons (ASPS) Resident Education Curriculum (REC) and relevant cited continuing medical education (CME) articles from Plastic & Reconstructive Surgery Journal (PRS). Each of these resources were searched and categorized by whether or not the correct answer could be found within each resource.
RESULTS:A total of 750 questions underwent analysis. Overall, Neligan's Plastic Surgery was the highest yield, comprising 57.6% of total averaged questions correct. This was followed by the REC which yielded 57.2%. The remaining resources from highest to lowest yield were as follows: Grabb & Smith's Plastic Surgery (56.3%), previous year's syllabi (33.7%), Green's Operative Hand Surgery (30.1%), and CME articles (28%) respectively. When the exam was broken into subcategories (Comprehensive, Hand & Lower Extremity, Craniomaxillofacial, Breast & Cosmetic, and Core Surgical Principles), the order of highest to lowest yield did not vary significantly with the exception of the Hand & Lower Extremity section, for which Green's Operative Hand Surgery contributed approximately 72% answers correct.
CONCLUSION:Overall, Neligan's Plastic Surgery and the Resident Education Curriculum were the highest yield resources for all topics averaged, with Green's Operative Hand Surgery being the highest yield for the Hand and Lower Extremity section. Some resources, particularly the Resident Education Curriculum, may not be frequently utilized despite its high yield nature. This study serves to identify gaps in resident study material and is a tool to identify top resources when devising a study plan to achieve the best performance possible on the examination.
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