title: Improving comfort and throughput for patients undergoing fractionated laser ablation of symptomatic burn scars.
abstract: BACKGROUND
  Utilization of fractionated ablation with a carbon dioxide (CO2) laser has shown to be efficacious in the management of symptomatic burn scars. Although effective, this procedure is painful and burn patients traditionally evidence low pain tolerance. For this reason intravenous anesthesia is used during these procedures. However, operative anesthetics and intravenous opioids are associated with patient discomfort postoperatively and prolonged recovery times. The American Society of Anesthesiologists' (ASA) Task Force on Acute Pain Management for the perioperative setting recommends the use of multimodal anesthesia, including the use of regional blockade with a local anesthetic. A quality improvement project was implemented to incorporate this practice and evaluate outcomes. The main goal of this project was to improve patient comfort as evidenced by improved pain scores with a decreased requirement for intravenous opioids post-procedure. The secondary goal of this project was to improve patient throughput in the setting of an outpatient surgical facility as evidenced by decreased time in the facility.
  
  
  METHODS
  A historic cohort of 36 cases was compared to 36 cases managed under the ASA guidelines for multimodal anesthesia utilizing a topical local anesthetic. Statistical analysis included a t-test for continuous variables while chi square was utilized to analysis dichotomous variables.
  
  
  RESULTS
  Intravenous narcotic utilization and mean pain scores in the recovery phase of care were significantly reduced as a result of adoption of the ASA recommendations. Throughput time increased by 36 minutes; notably in the preoperative phase, while patient movement through the procedural phase was significantly decreased as was procedure to discharge times.
  
  
  CONCLUSIONS
  Implementing the use of a topical anesthetic as a component of multimodal anesthesia for patients undergoing fractionated laser ablation of symptomatic burn scars can significantly decrease patient pain and the need for intravenous opioids during the recovery phase of care. Increased overall throughput times were noted primarily in the preoperative period, while procedure to discharge times decreased. As operative and recovery phases represent higher operational costs, decreased time in these areas represent potential cost savings for the facility.
authors: From the *Division of Plastic Surgery, †NC Jaycee Burn Center, and ‡Department of Anesthesia, University of North Carolina Health Care System, Chapel Hill, NC; and §Duke University School of Nursing, Durham, NC.
authors: Renee E
authors: RE
authors: Edkins
authors: C Scott
authors: CS
authors: Hultman
authors: Paul
authors: P
authors: Collins
authors: Bruce
authors: B
authors: Cairns
authors: Marilyn
authors: M
authors: Hanson
authors: Margaret
authors: M
authors: Carman
mesh_terms: D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use; D002056:Burns / Q000150:complications*; D017439:Cicatrix, Hypertrophic / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011318:Prilocaine / Q000627:therapeutic use; D058996:Quality Improvement; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011318:Prilocaine; D008012:Lidocaine