Regional Anesthesia Use in Pediatric Burn Surgery: A Descriptive Retrospective Series.

Michael Richman,Jeffrey M Berman,Elizabeth M Ross

doi:10.7759/cureus.19063

Abstract

Pediatric burns are a common and often devastating injury. Treatment, reconstruction, and rehabilitation are painful experiences. For some, the experience triggers post-traumatic stress disorder and/or a chronic pain syndrome. Given the role pain plays as a major secondary disease, it must be addressed to achieve optimal healing. Regional anesthesia has been used extensively to manage postoperative pain and reduce the need for opioids following other surgical procedures in children. However, regional anesthesia is not widely used in pediatric burn care. We present a descriptive, retrospective case series of 15 pediatric burn patients who received regional anesthesia as part of their intra-operative pain management. In our patient population, we saw low levels of anesthetic as well as opioid usage with well-controlled pain. In this cohort, 93% of patients scored a 0/10 on the Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain by post-anesthesia care unit (PACU) discharge, with an average PACU stay of 70 minutes. Thirty-three percent of patients received no opioids, with the average opioid dose being 0.06mg/kg morphine equivalents. This case series serves to make clinicians aware of the feasibility of use and benefits of regional anesthesia in pediatric burn patients requiring operative repair.

Highlights

Burn injuries are the most common injury to pediatric patients in the world, accounting for approximately 2500 fatalities annually in the United States [1]
We analyzed the perioperative period of these patients to determine the type of regional block, type and dose of local anesthetic used, intra-operative analgesic and anesthetic usage, anesthesia time, as well as immediate postoperative analgesic usage, pain levels, and time spent in the post-anesthesia care unit (PACU)
Based on the American Society of Anesthesiologists (ASA) criteria, all patients were classified as ASA I or II

Summary

Introduction

Burn injuries are the most common injury to pediatric patients in the world, accounting for approximately 2500 fatalities annually in the United States [1]. Of those reported, scald burns are the main culprit in children younger than five years of age, while flame-related burns are more commonly associated with older children and adolescents [2]. Scald burns are the main culprit in children younger than five years of age, while flame-related burns are more commonly associated with older children and adolescents [2] Burns are traumatic both physically and emotionally, especially to vulnerable children. Wollgarten-Hadamek demonstrated that children aged nine to sixteen years who had suffered moderate to severe burns at age six to twenty-four months had long-term alterations in somatosensory and pain processing [4]

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Conclusion