Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults.
BACKGROUND
Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults.


METHODS
Sixty-nine adult patients with burns covering ≥ 30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge.


RESULTS
Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P < 0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm(2) compared to control (P = 0.002).


CONCLUSIONS
Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. arhali@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. arhali@utmb.edu.
Arham
A
Ali
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. dherndon@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. dherndon@utmb.edu.
David N
DN
Herndon
School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. asmamach@utmb.edu.
Ashish
A
Mamachen
School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. sshasan@utmb.edu.
Samir
S
Hasan
Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. clanders@utmb.edu.
Clark R
CR
Andersen
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. ragrogan@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. ragrogan@utmb.edu.
Ro-Jon
RJ
Grogans
School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. jbrewer@utmb.edu.
Jordan L
JL
Brewer
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. jolee@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. jolee@utmb.edu.
Jong O
JO
Lee
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. jaheffer@utmb.edu.
Jamie
J
Heffernan
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. oesuman@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. oesuman@utmb.edu.
Oscar E
OE
Suman
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. ccfinner@utmb.edu.|Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA. ccfinner@utmb.edu.|Institute for Translational Sciences and the Sealy Center for Molecular Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA. ccfinner@utmb.edu.
Celeste C
CC
Finnerty
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002056:Burns / Q000188:drug therapy* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000009:adverse effects*; D014945:Wound Healing / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D011433:Propranolol