Ultrasound-Guided Axillary Brachial Plexus Block for the Management of Graft Site Pain During Dressing Change in the Burn-Injured Patient: A Randomized Control Trial

Author:

Town Cienwen J12ORCID,Strand Haakan2,Johnson James1,Van Zundert André134

Affiliation:

1. Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital , Queensland , Australia

2. University of Queensland, School of Nursing, Midwifery and Social Work , Australia

3. University of Queensland Faculty of Medicine & Biomedical Sciences , Australia

4. University of Queensland Burns, Trauma & Critical Care Research Centre , Australia

Abstract

Abstract Burn injuries requiring split-thickness skin grafting procedures often require ongoing wound aggravation in the form of dressing changes. These dressing changes may cause significant pain due to stimulation of damaged nerve endings in the epidermal layer. A randomized control trial, pilot study, was undertaken to evaluate the impact of ultrasound-guided regional nerve block on the outcome of patient reported pain scores by inpatients requiring dressing changes for hand and upper limb burn injuries. Twenty participants aged >18 years, requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit between August 2018 and September 2020. Participants were randomized to control (10 participants) or intervention group (10 participants). All participants received analgesia as per their treating team, the intervention group received the addition of an ultrasound-guided axillary brachial plexus block prior to their dressing change procedure. The primary outcome was to assess perceived pain at the graft site as measured by the Numeric Pain Rating Scale (0–10) before, during, and after dressing change procedure. There was strong evidence of a difference in the adjusted mean change score between groups, with a mean reduction of 4.3 in the intervention group, indicating reduced pain, and a mean increase of 1.2 in the control group (P < .001). No adverse events occurred in either group, and the addition of ultrasound-guided regional anesthesia (RA) for the treatment of dressing pain was determined to be a safe and effective intervention.

Publisher

Oxford University Press (OUP)

Subject

Rehabilitation,Emergency Medicine,Surgery

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