Early multimodal pain relief is essential when managing acute pain in patients with burn injuries. “If acute pain is poorly managed, patients with burns may have a higher risk for developing long-term chronic pain and psychiatric trauma,” explains Cienwen J. Town, GradCertEd, BN. In addition, some patients may be treated with opioids—either alone or in conjunction with other analgesics and sedatives—to provide pain relief, but these therapies come with well-documented risks.
Recently, researchers have explored the addition of targeted, regional anesthesia via sensory blockade to manage pain in patients with burn injuries. Ultrasound-guided regional anesthesia provides local anesthetics safely and effectively to a targeted nerve or bundle of nerves. However, few studies have assessed this treatment approach for graft site pain during dressing changes in patients with burns.
Regional Anesthesia to Address Graft Site Pain
For a study published in the Journal of Burn Care & Research, Town and colleagues evaluated the efficacy of an ultrasound-guided regional nerve block as a pain-relieving intervention in patients requiring postoperative dressing changes for hand and upper limb burn injuries. The study included adults who underwent split-skin grafting for burn injuries that were more than 15% of the total body surface area (TBSA).
All participants in the study received analgesia as treatment, but the intervention group also received an ultrasound-guided axillary brachial plexus block prior to their dressing change procedure. The research team then assessed perceived pain at the graft site, which was measured by the Numeric Pain Rating Scale (NPRS) before, during, and after dressing change procedures.
Ultrasound-Guided Regional Anesthesia Reduces Pain
Results from the study showed that mean NPRS scores were lower for the intervention group than the control group, indicating reduced pain when adding an ultrasound-guided axillary brachial plexus block prior to dressing change procedures. Patients in the intervention group had a mean NPRS reduction of 4.3, compared with a mean increase of 1.2 for the control group (Table). There were no significant differences in pre-dressing pain scores between groups, and no adverse events occurred in either group.
Morphine equivalent pain relief consumption was higher for patients in the intervention group across all time points, possibly due to a number of factors, including larger affected TBSA. While the intervention group required higher morphine equivalent doses overall, their background pain scores were comparable to those of the control group. Furthermore, the increase in opioid requirement during dressing changes was clinically representative of the increase in pain experienced by the control group.
Collectively, the findings demonstrate the effectiveness of regional nerve blocks for managing procedural pain during upper limb dressing changes in patients with burns. The researchers noted that all intervention group participants said they would opt to receive a regional nerve block again in the future.
A Safe & More Precise Addition to Multimodal Pain Relief
Based on the results, Town says regional anesthesia should be considered as an option to help manage pain for patients with burn injuries. “These treatments have become increasingly popular over the last 3 decades, and their application to patients with burns should not be overlooked,” she says. Ultrasound-guided regional nerve blocks have the potential to significantly reduce pain while providing a safe and effective addition to multimodal pain relief.
According to the authors, successful implementation of regional blocks for burns relies on having trained anesthetists and appropriate monitoring equipment, but the potential benefits are significant. Administering regional nerve blocks for dressing changes may reduce needs for additional general anesthetics in some patients. This is important because providing general anesthesia for dressing changes requires significantly more hospital resources and confers additional risk and recovery time for patients.