Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting

Chee-Kwan Kong1, Alizan Abdul Khalil2, Ahmad Sukari Halim3

1 Department of Surgery, University Malaya Medical Centre, Lembah Pantai, 59100, Malaysia,
2 Department of Surgery, University Malaya Medical Centre, Lembah Pantai, 59100, Malaysia,
3 Reconstructive Science Unit, University Sains Malaysia, 16150 Kota Bharu, Malaysia, ashalim@usm.m


It has been known that the split skin graft donor site is more painful than the recipient site itself.  Despite its frequent usage, the donor site preparation protocol has not been standardized.  This prospective study determined the benefit and risk of bupivacaine with epinephrine infiltration before harvesting skin graft under general anesthesia.


Sixty consecutive patients admitted to our center were randomized into either the infiltration group or no infiltration group.  Post-operatively, all the patients were given patient-controlled morphine to monitor opioid requirement.  Pain score was assessed using visual analog scale postoperatively until 24 hours. Mann-Whitney U statistical test was used to assess pain score and opioid requirements.


Total 53 of the 60 (88.3%) recruited subjects participated in the research until completion.  There was significant difference in pain intensity between the two groups from 8 to 20 hours post-operatively (p <0.05).  The difference between the two groups on cumulative usage of PCA morphine was also significant from 8 to 16 hours post-operatively.   There was no neuro-cardiotoxicity detected in both group of patients.  None of the donor sites was infected and all healed completely by one month review.


Subcutaneous infiltration of bupivacaine with epinephrine before harvesting of split skin graft under general anesthesia improved postoperative analgesia and decreased opioid consumption.  No sign of any toxicity or wound infection observed.  It is a safe procedure in the selected group of patients.  Therefore, this technique is strongly recommended to be routinely practiced to improve postoperative care of skin graft patients.

Key Words

Skin graft harvest, pain control, bupivacaine, infiltration, safety


Dr Chee-Kwan Kong obtained his undergraduate medical degree at a local university in Malaysia, University Sains Sarawak. After completed his compulsory rural service, he went on to pursue his surgical training in several public hospitals in Malaysia. Currently, he is doing plastic surgery fellowship in a university hospital. He has special interest in burns and reconstructive surgery.

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