Effect of topical local anesthetic application to skin harvest sites for pain management in burn patients undergoing skin-grafting procedures

Objective To determine if topical administration of local anesthesia, appli ed to fresh skin-harvest sites, reduces pain and analgesic requirements aft er surgery. Summary Background Data Nonopioid treatments for pain after therapeutic pro cedures on patients with burns have become popular because of the side effe cts associated with narcotics. The topical administration of local anesthes ia originally offered little advantage because of poor epidermal penetratio n. Methods This study compares 2% lidocaine with 0.5% bupivacaine or saline, t opically applied after skin harvest, to determine what effect this may have on pain and narcotic use. Sixty patients with partial- or full-thickness b urns to approximately 10% to 15% of their body were randomly divided into t hree groups: group I received normal saline, group 2 had 0.5% bupivacaine, and group 3 had 2% lidocaine sprayed onto areas immediately after skin harv est. Blood samples were subsequently obtained to measure concentrations of the local anesthetic. Hemodynamic variables after surgery, wake-up times, e metic symptoms, pain, and narcotic use were compared. Results Higher heart rates were noted in the placebo group than in those re ceiving lidocaine or bupivacaine. No differences were noted in recovery fro m anesthesia or emetic symptoms. Pain scores were lower and 24-hour narcoti c use was less in patients who received lidocaine. Plasma lidocaine levels were greater than bupivacaine at all time points measured. Conclusions Topical lidocaine applied to skin-harvest sites produced an ana lgesic effect that reduced narcotic requirements compared with patients who received bupivacaine or placebo. Local anesthetic solutions aerosolized on to skin-harvest sites did not affect healing or produce toxic blood concent rations.