Techniques and strategies for regional anesthesia in acute burn care—a narrative review

Abstract

Burn injuries and their treatments result in severe pain. Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery, burn-injured patients endure pain for a prolonged period that lasts through wound closure (e.g. background pain, procedural pain, breakthrough pain, neuropathic pain and itch). Regional anesthesia, including peripheral nerve blocks and neuraxial/epidural anesthesia, offers significant benefits to a multimodal approach in pain treatment. A ‘regional-first’ approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients. A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter. The infra/supraclavicular nerve block provides excellent coverage for the upper extremity, while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks. The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites. Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events, including management of local anesthetic toxicity and epidural infections. Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage. Ultimately, regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.

Ultrasound-Guided Axillary Brachial Plexus Block for the Management of Graft Site Pain During Dressing Change in the Burn-Injured Patient: A Randomized Control Trial

“…The contraindications in this cohort are few, and the potential benefits are many. 5 , 11 To date there are no published clinical trials focusing on regional nerve blocks during burn dressing changes, this is likely due to a number of reasons including: perceived infection risk; poor access to experienced anesthetic clinicians and procedural equipment; focus on chronic pain interventions; and the paucity of published literature to guide a change in practice.…”

“…However, its application in burns is still underreported and underutilized. 5 In particular, an area of burn treatment that has yet to be explored in partnership with RA is that of dressing changes and postoperative procedural pain. Dressing changes typically occur 3 to 5 days post the split-skin grafting procedure and can involve removal of staples, minor debridement, and redressing or splinting.…”

Exploring anesthesiologist niche in burn management: Putting the tube where it belongs. A case series on difficult airways in burns

“…The use of local anesthetics agents decreases sensitization thereby decreasing the risk of development of chronic pain. 11 They also decrease the requirement of systemic analgesics thereby decreasing the chances of opioid addiction, overdose, tolerance, hyperalgesia, and sedation. Careful dose calculation of local anesthetic is important in burn patients as there are increased chances of (local anesthetic-induced systemic toxicity) due to high vascularity, decreased cardiac output, low-protein binding, and deranged liver and kidney function.…”

The Notch pathway attenuates burn-induced acute lung injury in rats by repressing reactive oxygen species

“…Severe burns are often accompanied by fatal complications, of which ALI is one of the earliest and most severe complication [ 1 , 2 , 44 ]. Mounting evidence indicates that PMVEC injury and the accumulation of ROS play an essential role in ALI development [ 7 , 14 ].…”