title: Post-operative pain control for burn reconstructive surgery in a resource-restricted country with subcutaneous infusion of local anesthetics through a soaker catheter to the surgical site: Preliminary results.
abstract: OBJECTIVE
  Post-operative pain can significantly affect a patient's ability to recover following surgery. In this study we introduced the concept of post-operative pain evaluation of burn patients as well as a technique for placement and use of subcutaneous catheters for continuous infusion of local anesthetic to provide analgesia following skin harvest from the lateral thigh in a hospital in resource-restricted country--Ukraine.
  
  
  METHODS
  A total of 109 patients were enrolled in this study. In the control group 64 patients received the standard post-operative pain regimen of metamizole 1 g and/or ketorolac 3%- 30 mg at the discretion of the nursing staff. In the interventional group, 45 patients received the catheter infusion of local anesthetic by elastomeric pump which was placed intraoperatively; it continuously delivers a regulated flow 4-5 ml/h of procaine 0.5% for 48 h to a patient's surgical donor site with the standard pain regimen available for breakthrough pain. All patients were assessed post-operatively and in the peri-dressing change period by the nursing staff. Blood pressure, heart rate, and pain scores were documented based on the Wong-Baker Faces Pain Rating Scale. All data were analyzed using SAS version 9.3. The Student's t test and Fisher's exact test were used to assess differences between groups for continuous variables. The Mann-Whitney U Test was used to examine differences in pain scores between groups. A p value of <0.05 was considered significant.
  
  
  RESULTS
  The median pain score immediately following surgery was 5.0 in the control group, which was significantly greater (p=0.03) than median pain score of 4.0 for the patients receiving continuous infusion of procaine. However, there is no statistically significant difference in the median pain score (3.0 and 3.0) after the initial dressing change (p=0.73).
  
  
  CONCLUSIONS
  Our Ukrainian colleagues now have a method of objective pain assessment and a new technique in pain management. With assessment linked to intervention, improvement in post-operative pain can be expected.
authors.affiliation: Harvard Medical School, Massachusetts General Hospital, United States. Electronic address: gfuzaylov@mgh.harvard.edu.
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Fuzaylov
authors.affiliation: Anesthesia, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Tara L
authors.initials: TL
authors.lastname: Kelly
authors.affiliation: Anesthesia, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bline
authors.affiliation: Burn Center, Municipal Hospital #8, Lviv, Ukraine.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dunaev
authors.affiliation: Shriners Hospital for Children, Boston, MA 02114, United States.
authors.forename: Maggie L
authors.initials: ML
authors.lastname: Dylewski
authors.affiliation: Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 012114, United States.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Driscoll
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002056:Burns / Q000601:surgery*; D057785:Catheters; D004177:Dipyrone / Q000627:therapeutic use; D005260:Female; D006295:Health Resources; D006801:Humans; D007260:Infusion Pumps; D055104:Infusions, Subcutaneous; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation; D013848:Thigh; D020858:Tissue and Organ Harvesting; D014455:Ukraine; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004177:Dipyrone; D020910:Ketorolac
keywords: A reconstructive surgery; Burn; Local anesthetic infusion; Pain control; Recourse-limited country; Split thickness skin graft; Ukraine