The benefits of ultrasound-guided continuous sensory nerve blockade in the setting of burn injury: a case report of bilateral continuous superficial peroneal nerve blockade in a patient with severe sleep apnea.
The management of pain after burn injuries is a clinical challenge magnified in patients with significant comorbidities. Presently, burn pain is treated via a wide variety of modalities, including systemic pharmacotherapy and regional analgesia. Although the latter can provide effective pain control in patients with burn injuries, it is relatively underused. Furthermore, the development of ultrasound guidance has allowed for novel approaches and sparing of motor nerve blockade with preference toward sensory-specific analgesia that has not been possible previously. This can result in decreased opiate use and shorter latency to initiation of rehabilitation. In this report, we describe a patient with chronic pain, morbid obesity, and severe sleep apnea who presented with uncontrolled pain resulting from a burn injury to the dorsum of his feet. The treatment consisted of multimodal analgesia and placement of bilateral continuous superficial peroneal nerve catheters, as he underwent skin grafting and postprocedural hydrotherapy. This novel approach allowed for sparing of postprocedural opiates with positive clinical results.
University of Pittsburgh Medical Center Mercy Hospital, 1400 Locust St, Pittsburgh, PA 15219. Electronic address: shickv@upmc.edu.
Vladislav
V
Shick
University of Pittsburgh Medical Center Mercy Hospital, 1400 Locust St, Pittsburgh, PA 15219.
Evan E
EE
Lebovitz
University of Pittsburgh Medical Center Mercy Hospital, 1400 Locust St, Pittsburgh, PA 15219.
Emerson
E
Conrad
D002056:Burns / Q000150:complications / Q000628:therapy*; D059350:Chronic Pain / Q000209:etiology / Q000628:therapy; D018409:Foot Injuries / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010543:Peroneal Nerve / Q000000981:diagnostic imaging*; D016038:Skin Transplantation / Q000379:methods; D012891:Sleep Apnea Syndromes / Q000150:complications*; D018084:Ultrasonography, Interventional / Q000379:methods
Burn pain management; Multimodal analgesia; Obstructive sleep apnea; Use of regional analgesia to block sensory nerves