Retrospective audit of analgesia for 1ST SSG Surgery in the Victorian adult burns service The Alfred Hospital 2014-2017

Dr Kerry Mclaughlin1, Dr Kevin Pan1, Dr Kieran Bates1

1The Alfred, Prahran, Australia

Abstract:

Background:Management of Burns pain is challenging.1,2,3,4,5,6 Patients report that donor surgical site is the most debilitating.7,8 and often neuropathic in nature. There has been increasing interest in treating the neuropathic component of burns pain.9 Globally there is a drive to reduce the reliance on opioid based analgesic regimes.5
Poorly controlled acute pain is a risk factor for chronic pain10 and its associated reduction in physical, psychological and social functioning.11,12
Aims:Comparison of pain scores pre and post 1st SSG surgery in patients with burns injury.
Method:All patients with ≥10% burn requiring SSG admitted to the Victorian Adult Burns Service over a 4 year period were identified by the burns registry. Data was collected 24hrs pre SSG to 24hrs post SSG and included size of burn, pain scores, opioid and antineuropathic use including ketamine and lignocaine infusions.

Data:138 patients with >10%TBSA burns
20 Patients received lignocaine at time of SSG
The lignocaine group had larger TBSA burn 33.3% vs 27.7%, had longer hospital stays 43.5 days vs 33.4 days and more surgical encounters 5.45 vs 4.22
The difference between pre and post op pain scores was compared. The non-lignocaine group showed a significant post-operative increase (1.68, SE=0.32, p<0.001). The difference was lower for the lignocaine group (0.18, SE=0.79, p=0.822).
Preoperative pain scores were comparatively higher in the lignocaine group 4.83 Vs 2.88 suggesting this group had harder to manage pain. This supports the hypothesis that there is a trend towards improvement in pain management in the lignocaine group.

Conclusion:Lignocaine infusion may reduce burns associated pain.
We propose a prospective randomised placebo controlled trial to assess the efficacy of IV lignocaine on donor site pain related to burns injury.
Bibliography
1. James DL, Jowza M, Principles of Burn Pain Management Clin Plastic Surg. 2017;44:737–747
2. Hyeong Tae Yang. Improvement of burn pain management through routine pain monitoring and pain management protocol. Burns(2013);39:619–624
3. Retrouvey H, Shahrokhi S. Pain and the Thermally Injured Patient—A Review of Current Therapies Journal of Burn Care & Research2015;36(2):315–323
4. Alencar de Castro RJ, Leal PL, Sakata RK. Pain Management in Burn Patients Rev Bras Anestesiol. 2013;63(1):149-158


Biography:

Kerry McLaughlin works as  a VMO Pain Specialist and Anaesthetist at the Alfred Hospital. Burns pain management is her areas of specialist interest.