Use of Continuous Local Anesthetic Infusion in the Management of Postoperative Split-Thickness Skin Graft Donor Site Pain

Abstract

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.

Ultrasound-Guided Regional Anesthesia for Pediatric Burn Reconstructive Surgery

“…Group 3 received a fascia-Iliaca block under ultrasound guidance of ropivacaine 0.2%; dose = 20 ml or 1 ml/kg for children < 20 kg. A catheter was left in place in group 3 infusing ropivacaine 0.1% at 0.15 cc/kg/hr [19-20]. Randomization was via a random number generator with equal distribution to all three groups.…”

Acute and Perioperative Care of the Burn-injured Patient

“…Patients often have more intense postoperative pain from the split-thickness skin donor site than from the grafted burn wound. Regional anesthesia in its simplest form may be tumescent local anesthesia injected into a donor site prior to harvesting 75 or it can take the form of subcutaneous catheter infusions, 76 peripheral nerve, or central neuraxial blocks. 77 …”

“…Sometimes there is a need to cover the anterior and medial thigh due to the extent of skin harvest, and therefore a fascia iliaca block can also be performed. 76–78 …”

Acute and Perioperative Care of the Burn-Injured Patient

“…Sometimes there is a need to cover the anterior and medial thigh due to the extent of skin harvest, and therefore a fascia iliaca block can also be performed. [76][77][78] …”

“…Patients often have more intense postoperative pain from the split-thickness skin donor site than from the grafted burn wound. Regional anesthesia in its simplest form may be tumescent local anesthesia injected into a donor site prior to harvesting 75 or it can take the form of subcutaneous catheter infusions, 76 peripheral nerve, or central neuraxial blocks. 77 Central neuraxial techniques (spinals, epidurals) have been utilized with good effect as both primary anesthetics and postoperative adjuncts in burn injured patients.…”