背景:皮肤烧伤通常用自体皮肤移植治疗。植皮后,许多患者抱怨捐赠部位疼痛。供体部位最常见于大腿外侧,由股外侧皮神经(LFCN)支配。LFCN阻断的使用应减少来自供体位点的伤害感受。
方法:我们的团队于2019年开始使用LFCN模块。利用解剖标志,对所有接受自体皮肤移植的患者进行LFCN阻滞,以减轻围手术期疼痛。对所有接受自体皮肤移植的全身面积烧伤10%或以下的患者进行了回顾性队列研究。从2016年开始的类似队列,在使用任何局部或区域镇痛之前,被用作历史控制。在手术后的每一天至第5天或出院(以先到者为准)收集术后肠内和肠胃外麻醉镇痛药,并转换为吗啡毫克当量(MME)以量化手术后的镇痛。
结果:图表回顾确定了2020年队列中的55名患者。来自2016年队列的55名患者根据皮肤移植物的大小进行匹配,全身表面积(TBSA)烧伤,性别,和年龄。两组移植物大小无统计学差异,TBSA烧毁,年龄,性别,或烧伤类型。在围手术期(第0-2天)检查麻醉剂使用情况时,我们发现两组的总MME(113vs133,p=0.28)或IVMME(38vs33,p=0.45)没有差异.在延长的术后期间(第1-5天),总MME(149vs.188,t=0.22)或IVMME(37与50,t=0.25)。检查每日麻醉药的使用也没有得出统计学上不同的值。
结论:我们的数据表明,通过具有里程碑意义的技术使用LFCN阻断并没有减少接受植皮手术的患者的麻醉药使用。未来的研究应该考虑超声引导的LFCN块。
BACKGROUND: Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site.
METHODS: Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery.
RESULTS: Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values.
CONCLUSIONS: Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks.