Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients

Claes, Karel; Amar, S.; Hoeksema, Henk; Kornhaber, Rachel; Jong, Alette de; Monstrey, Stan; Haik, Josef; Biroš, Erik; Harats, Moti

doi:10.1016/j.burns.2021.05.018

Cited by 15 publications

(15 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ketamine), sedation (e.g. midazolam), and/or locoregional blocks should be tailored accordingly 90,91 . Patient satisfaction was reported as high when adequate pain management with analgosedation, or locoregional anaesthesia was utilized 92 …”

Section: Discussionmentioning

confidence: 99%

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

Shoham

Gasteratos²,

Singer

et al. 2023

International Wound Journal

View full text Add to dashboard Cite

In 2012 the European Medicines Agency approved a pineapple stem‐derived Bromelain‐based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013–2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta‐Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain‐based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non‐surgical eschar removal treatment modality. The benefits of Bromelain‐based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain‐based debridement are expanding to cover “off‐label” cases with significant benefits to the global healthcare economy.

show abstract

Section: Discussionmentioning

confidence: 99%

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

Shoham

Gasteratos²,

Singer

et al. 2023

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…Indeed, we witnessed elevated pain scores in our patients prior to administering intravenous anesthesia and therefore recommend initiating appropriate anesthesia earlier, in addition to premedication with analgesics. Other pain management modalities worth considering have been reported, including nerve blocks [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

Алексеев

Malyutina

Bobrovnikov

et al. 2023

Life

View full text Add to dashboard Cite

Since its approval in Europe a decade ago, NexoBrid® enzymatic debridement of deep thermal burns has been gaining acceptance as standard practice around the world. The purpose of this study is to report the first experience with NexoBrid® in the Russian Federation. During 2019–2020, we conducted a post-registration clinical study assessing the safety and treatment results of NexoBrid® enzymatic debridement. The study involved 15 adult patients suffering from deep thermal burns over an area ≤15% of their total body surface area. Patients were treated with NexoBrid® within 3 days of injury, followed by spontaneous or surgical wound closure. Complete eschar removal was achieved in twelve patients, 80% eschar removal in two patients, and 70% in one patient. Complete spontaneous epithelialization of wounds was achieved in 12 patients (80%) within 18 ± 1.9 days after the start of treatment. We did not witness pathological scarring during follow-up, and there were no significant safety issues throughout the study. Early use of NexoBrid® resulted in rapid, effective, and safe eschar removal with good results and sufficient preservation of viable dermis to allow for spontaneous healing in 80% of patients. These results demonstrate the ability to minimize surgical intervention and hopefully lead to better long-term scarring results.

show abstract

“…The pretreatment risk stratification, adequate monitoring and hemodynamic support are needed when treating patients on more than 15% TBSA [ 15 , 16 , 17 ]. The literature lacks studies reporting the use of enzymatic debridement in children, with the exception of one manuscript presenting the combined experience in the use of Nexobrid ® in pediatric burns throughout three clinical trials, and the study that explores the different possibilities for pain management during enzymatic debridement in pediatric and adult burn patients [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Korzeniowski

Grywalska

Strużyna

et al. 2022

JCM

View full text Add to dashboard Cite

Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.

show abstract

Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients

Cited by 15 publications

References 47 publications

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Contact Info

Product

Resources

About