The long-term analgesic efficacy of a single-shot fascia iliaca compartment block in burn patients undergoing skin-grafting procedures.
In a previous study, we assessed the efficacy of a continuous fascia iliaca compartment block (FICB) in reducing the pain at thigh autograft skin donor sites. However, a continuous local anesthetic infusion may cause toxicity or infection. In this prospective, randomized double-blind study, we compared the analgesic efficacy of FICB when given as a single shot vs continuous infusion during the 72-hour postoperative period up to the first dressing change (1dc). After ethical committee approval and informed consent, 81 adults (with 1% to 20% total burn surface area) who were scheduled for split-skin graft harvest procedures of the thigh underwent the FICB procedure before general or spinal anesthesia. Via FICB, patients received a bolus of 40 ml followed by 10 ml/hr consisting of either ropivacaine 0.2% for bolus and infusion (continuous, n = 27), or ropivacaine 0.2% for bolus and saline for infusion (single-shot, n = 27), or saline for both bolus and infusion (control, n = 27) until 1dc. Postoperative analgesia consisted of morphine via a patient-controlled analgesia device. We compared cumulative morphine consumption, static and dynamic pain scores, and side effects related to morphine or ropivacaine during the 72 hours up to 1dc. A single block had the same morphine sparing-effect as the continuous technique. Both techniques were equally effective in diminishing dynamic pain and reducing the side effects normally associated with morphine. However, patients receiving a single block experienced less residual paresia and were more satisfied with their pain-relief treatment than those who received a continuous infusion. A single-shot FICB is an easy, inexpensive, and efficient method for diminishing pain at thigh donor sites during a 72-hour postoperative period and has limited side effects and no residual paresia.
Cuignet
O
O
Burn Center, Queen Astrid Military Hospital, Military Medical Research Program and Development Committee, Brussels, Belgium.
Mbuyamba
J
J
Pirson
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D002037:Bundle-Branch Block; D002056:Burns / Q000628:therapy*; D005205:Fascia; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D000077212:Ropivacaine; D016038:Skin Transplantation / Q000009:adverse effects*; D013848:Thigh; D014182:Transplantation, Autologous
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine