Dr Tim Wang1, Dr Bish Soliman, Dr Shane O’Neill, Dr Jeon Cha
1Royal North Shore Hospital Sydney – Severe Burns Unit, Sydney, Australia
Use of opioids in burns injury is limited by sedation, nausea and development of tolerance.1 Intravenous lignocaine infusion has gained popularity as an effective adjunct in complex abdominal surgery and neuropathic pain. Systemic lignocaine reduces nociceptive afferent nerve conduction, dorsal horn neural transmission and also modifies cerebral perception of pain.2 3 Experimental studies also demonstrate its anti-inflammatory properties which can inhibit burns oedema and ischaemia via suppression of free radical and histamine release.4 In spite of above, its use in burns surgery has been limited.
Methods: A systematic review was conducted of all studies involving the use of intravenous lignocaine infusion for background or procedural burns pain management.
Results: Four articles were identified. For procedural pain, a randomised controlled trial (RCT) at the Victorian Burns Unit showed addition of lignocaine to morphine patient controlled analgesia (PCA) resulted in statistically reduced verbal reported pain scores OR (0.36 (95% CI 0.17-0.55)) compared to placebo.5 For background pain, a bolus dose of 1mg/kg iv lignocaine followed by an infusion significantly reduced pain visual analogue scale (VAS) scores from 81 down to 17 after 2hours of administration (p<0.05).1 A recent RCT of its use in patients >10%TBSA burns showed an opioid sparing effect of 25% in all burns with the larger TBSA burns reducing opioid use by 50%.6 All patients within these two trials did not experience any significant side-effects.
Conclusion: Lignocaine infusion is an effective adjunct in the management of post-burns pain with minimal complications. Further studies are required to elucidate the optimal administration regimen and patients most likely to benefit.
Dr Tim Wang is a post-fellowship senior registrar in Plastic Surgery at Royal North Shore Hospital with an interest in microsurgery, hand surgery and burns.
Raised in Scandinavia, Tim obtained his medical degree from Imperial College London, preceptorship in plastic surgery at Harvard University Beth Israel Deaconess Medical Centre and a Masters in plastic surgery from the University of Sydney. Outside of work he enjoys wrestling two young children, swimming, travel and photography.
Tim’s main aim is to use research as a means to optimise current clinical practice and improve patient care.