Regional Anesthetic Blocks for Donor Site Pain in Burn Patients: A Meta-Analysis on Efficacy, Outcomes and Cost
Katherine A. Grunzweig, M.D., Ji Son, M.D., Anand R. Kumar, M.D..
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Purpose: In the clinical care of patients with burn injuries requiring grafting, skin graft donor site pain significantly affects pain management, narcotic use, and hospital length of stay. We proposed to evaluate the efficacy of regional anesthesia to decrease narcotic consumption, and to assess the impact on hospitalization costs via meta-analysis. We hypothesized that regional anesthesia at donor sites would significantly decrease pain and narcotic consumption, as well as decrease total hospital costs compared to non-regional pain management.
Methods: Using PRISMA criteria, PubMed/MEDLINE, Embase and ScienceDirect were searched with the following inclusion criteria: comparative studies, adult populations, burn patients, autologous skin grafting, regional nerve blocks and traditional narcotic regimens. MINORS criteria assessed methodological rigor of included studies. Outcomes assessed included narcotic consumption, pain scores, and opioid side effects. Meta-analysis obtained pooled values for morphine consumption and side effects. Cost analysis was performed using published data in the literature.
Results: Final analysis included 101 patients. Cumulative morphine consumption at 72 hours was lower for patients treated with regional anesthesia (fascia iliaca compartment block) versus patient-controlled analgesia (single shot regional 25 ± 12mg; continuous regional 23 ± 16mg; control 91.5 ± 24.5mg; p<0.05). Regional anesthesia decreased nausea/vomiting (p<0.05), and lowered subjective pain scores. Morphine PCA was estimated to cost $98/day, single shot $49.85, and continuous $82.59/day. Regional anesthesia interventions cost less than PCA (p<0.05).
Conclusions: Regional anesthesia at skin graft donor sites significantly decreases narcotic consumption in burn patients. Single shot anesthesia is less expensive and as effective as continuous. Regional anesthesia is cost-effective, decreases side effects, and may result in shorter hospital stays due to improved pain management.
Table 1. Cumulative Morphine Requirements
|Continuous Regional||Single Shot Regional||Non-Regional (Control)||P-Value|
|Average Morphine/Day (mg) ± SD*|
|POD0||6.5 ± 3.5||6 ± 3||20.5 ± 8|
|POD1||11 ± 6.5||11 ± 6||44.5 ± 14.5|
|POD2||16.5 ± 9.5||19 ± 9||74 ± 21.5|
|POD3||23 ± 16||25 ± 12||91.5 ± 24.5||0.00**|
*SD = Standard Deviation; **ANOVA performed
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