Intraoperative Dexmedetomidine for Analgesia during Burn Excision and Grafting

Abstract

Abstract

Patients with superficial burns normally do not require surgical intervention, however, burns that are deep and large, require numerous procedures for excision and skin grafting (EG).¹ Consequently, the complicated care of these patients is often transferred into the hands of their anesthesia providers. One of the challenges with these patients lies in their multi-faceted, but common theme of pain, which is confounded not only by high inter-patient variability and unpredictability^{1, 2} , but by pain from the initial injury, by wound care pain and by the new, postoperative pain from EG procedures.¹ Furthermore, because of tolerance and hyperalgesia, increasing doses of narcotics may be required and yet fail to provide adequate relief and sadly, ineffective pain control can be associated with poor emotional health including, but not limited to, depression and post-traumatic stress disorder.^1,2,3 Clearly, the complexity of burns requires a thoughtful approach to analgesia.  

This case report details the utilization of dexmedetomidine as an adjunct for analgesia during EG for a severely burned patient. Anesthetic technique as well as immediate postoperative course for similar EG procedures were compared but limited to 5 procedures over a 20-day timeframe. The anesthetic specific to this case report was the only anesthetic in which Dexmedetomidine was utilized. Findings are consistent with the evidence and reveal on the day Dexmedetomidine was used, the patient had lower post-operative pain scores, lower postoperative Richmond Agitation Sedation Scores (RASS), and it was the only day the patient did not require any postoperative PRN pain medication administration.

Although limited evidence exists specifically related to the use of intraoperative dexmedetomidine for EG of severe burns, this case report suggests a promising role for the addition of this a₂ agonist as a multi-modal approach to caring for this complex population.

References

1. Ray DE, Karlekar MB, Crouse DL, et al. Care of the critically ill burn patient. Ann Am Thorac Soc. 2017;12(7):1094-1102. DOI: 10.1513/AnnalsATS.201607-577PS


2. Retrouvey H, Shahrokhi S. Pain and the thermally injured patient—A review of current therapies. Journal of Burn Care & Research. 2015;36(2):315-323. DOI: 10.1097/BCR.0000000000000073


3. Bittner E, Shank E, Woodson L, Martyn J. Acute and perioperative care of the burn-injured patient. Anesthesiology. 2015;122(2):448-464. DOI: 10.1097/ALN.0000000000000559