Burns : journal of the International Society for Burn Injuries
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Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures. ⋯ In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
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The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. ⋯ The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.
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Blood transfusion is an important treatment for patients with major burns. Understanding the predictive factors of blood product usage in major burns can improve effective transfusion therapy. We retrospectively reviewed the medical records of the Burn Center, First Affiliated Hospital of the Chinese Naval Military Medical University, from August 2009 to July 2019 and enrolled all patients with major burns treated in that decade. ⋯ Blood use or volume correlated with prognosis; especially, platelet and cryoprecipitate use was significantly associated with increased mortality. Blood product usage in major burns patients is related not only to the clinical condition, but also to doctors' experience, which can predict prognosis. Blood use is associated with increased mortality, although we found no evidence of a causal association.