Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis |
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| Affiliation: | 1. Department of Clinical Research, Shriners Hospitals for Children – Boston, Boston, MA, United States;2. Boston University School of Medicine, Boston, MA, United States;3. Harvard Medical School, Boston, MA, United States;4. Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children – Boston, Boston, MA, United States;5. Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States;6. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States;1. Centre for Applied Psychology, School of Health Sciences, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia;2. Bornhoffen Leadership Development Centre, Police Citizens Youth Clubs, 3510 Nerang Murwillumbah Road, Natural Bridge, Queensland 4211, Australia;3. Occupational Therapy Department, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland 4101, Australia;4. Centre for Children’s Burns and Trauma Research, The University of Queensland, Child Health Research Centre, 62 Graham Street, South Brisbane, Queensland 4101, Australia;1. Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada;2. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada;1. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA;2. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA;3. Occupational Therapy Program, Stony Brook University, NY, USA;4. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;5. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;6. Shriners Hospitals for Children-Boston®, Boston, MA, USA |
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| Abstract: | BackgroundPostoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures.MethodsThis retrospective analysis included patients aged 14–25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed.ResultsIn the authors’ five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0–4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0–24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant.ConclusionIn this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population. |
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| Keywords: | Liposomal bupivacaine EXPAREL Pediatric burns Pain control Donor site Skin graft |
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