Neuraxial anesthesia and pain control for pediatric burn patients receiving excision and split‐thickness skin grafts—A retrospective case series. Issue 10 (2nd August 2021)

• Record Type: Journal Article
• Authors: Liu, John; Chen, Joy; Nguyen, Phat‐Tan
• Editors: Veyckemans, Francis
• Is Part Of: Paediatric anaesthesia. Volume 31:Issue 10(2021)
• Page Start: 1113
• Page End: 1120
• Publication Date: 2021-08-02
• Subjects: anesthesia -- burn -- epidural -- pain management -- pediatric -- regional -- spinal; Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.14256
• Languages: English
• ISSNs: 1155-5645

Abstract

Abstract: Background: Postoperative pain management in pediatric burn patients requiring excision and split‐thickness skin grafts remains largely under‐studied. ICU care is often necessary due to the level of sedation and amount of opioids required to achieve adequate pain control. Aims: Our case series aimed to describe a pain management strategy using neuraxial anesthesia intraoperatively. Primary outcomes include pain scores, postoperative opioid consumption, and adverse events. Methods: A retrospective chart review was performed on a total of 61 patients who received intraoperative neuraxial anesthesia for split‐thickness skin grafting between January 1st, 2017 and June 1st, 2018. Patient demographics, operating room data, and subsequent hospital course was extracted from their electronic medical record and plotted using R Studio statistical software. Results: The overwhelming majority of patients received single‐shot spinals with both local anesthetic and either morphine or hydromorphone. Average pain scores were 1 out of 10 with standard deviation of 1.6 in the immediate postoperative period and decreased over the next 72 h. Oral morphine equivalents consumed did not exceed 0.61 ME/kg/day. The most common adverse reaction was pruritus. Conclusions: Spinal anesthesia was most commonly used for split‐thickness skin grafting in the pediatric burn population and provides excellent analgesia for patients' immediate postoperative course, including their initial dressing changes, with minimal risk for complications. Pain was well‐controlled in all subgroups indicating that this strategy can be used flexibly in a variety of pediatric burn patients.