title: Anesthetic Practices for Laser Rehabilitation of Pediatric Hypertrophic Burn Scars.
abstract: The use of ablative fractional carbon dioxide laser therapy and pulsed dye laser therapy has led to significant improvements in the rehabilitation of hypertrophic burn scars. However, laser procedures are associated with appreciable pain among pediatric patients. Clinical consensus suggests using general anesthesia for pediatric laser procedures; however, guidelines for perioperative care are lacking. The objective of this quality improvement study is to determine whether a difference exists in postoperative pain outcomes in pediatric patients who receive intraoperative opioid regimens compared with patients who receive opioid-sparing regimens for laser therapy of hypertrophic burn scars. A retrospective review of patients who received laser therapy at a pediatric burn center from April 2014 to May 2015 was performed. Overall, 88 of the 92 procedures reviewed were included. A statistically significant difference was not found between the likelihood of postoperative pain when intraoperative opioid regimens (n = 63) were given compared with opioid-sparing regimens (n = 25) X (1, n = 88) = 2.870, P = .0902. There was also no difference between short-acting (n = 48), long-acting (n = 9), or combination (n = 6) intraoperative opioids compared with opioid-sparing regimens (n = 25) in the likelihood of postoperative pain. Despite the small sample size, the low number of postoperative pain cases is encouraging. Ultimately, these data provide a foundation for developing anesthetic guidelines for pediatric laser procedures. Specifically, clinicians should consider the potential to deliver adequate perioperative care via an opioid-sparing regimen ± adjuvant.
authors.affiliation: From the *Department of Plastic Surgery, and †Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Wong
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Keilman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zuccaro
authors.forename: Charis
authors.initials: C
authors.lastname: Kelly
authors.forename: Jason T
authors.initials: JT
authors.lastname: Maynes
authors.forename: Joel S
authors.initials: JS
authors.lastname: Fish
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000627:therapeutic use*; D001707:Biopsy, Needle; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002170:Canada; D002648:Child; D002675:Child, Preschool; D017439:Cicatrix, Hypertrophic / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use; D008297:Male; D010147:Pain Measurement; D061214:Patient Safety; D019990:Perioperative Care / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics