title: Use of continuous local anesthetic infusion in the management of postoperative split-thickness skin graft donor site pain.
abstract: Donor sites from split-thickness skin grafts (STSG) impose significant pain on patients in the early postoperative period. We report the use of continuous local anesthetic infusion as a method for the management of postoperative STSG donor site pain. Patients undergoing single or dual, adjacent STSG harvest from the thigh (eight patients) or back (one patient) were included in this study. Immediately after STSG harvest, subcutaneous catheters were placed for continuous infusion of local anesthetic. Daily donor site-specific pain severity scores were prospectively recorded in nine patients receiving local anesthetic infusion. Patient characteristics, technical aspects, and postoperative complications were identified in the study. The thigh was the anatomic location chosen for most donor sites. A single catheter was placed for donor sites limited to 4 inches in width or less. A dual catheter system was used for those wider than 4 inches. An elastomeric pump delivered continuously a total of 4 ml/hr of a solution of 0.5% bupivacaine. The average anesthetic infusion duration was 3.1 days. A substantial decrease in worst, least, and average donor site pain scores was found from the first 24 hours to the second postoperative day in our patients, a treatment trend that continued through postoperative day 3. One patient developed minor anesthetic leakage from the catheter insertion site; and in three cases, accidental dislodgement of the catheters occurred. There were no cases of donor site secondary infection. All donor sites were completely epithelialized at 1-month follow-up. Continuous local anesthetic infusion is technically feasible and may represent an option for postoperative donor site pain control after STSG harvesting. Relative cost-benefit of the technique remains to be determined.
authors.affiliation: Department of Surgery, Section of Burns/Trauma/Critical Care, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT 06610, USA.
authors.forename: Jorge L Reguero
authors.initials: JL
authors.lastname: Hernandez
authors.forename: Alisa
authors.initials: A
authors.lastname: Savetamal
authors.forename: Roselle E
authors.initials: RE
authors.lastname: Crombie
authors.forename: Walter
authors.initials: W
authors.lastname: Cholewczynski
authors.forename: Nabil
authors.initials: N
authors.lastname: Atweh
authors.forename: Paul
authors.initials: P
authors.lastname: Possenti
authors.forename: John T
authors.initials: JT
authors.lastname: Schulz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D013524:Surgical Flaps; D060053:Transplant Donor Site
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine