Burn injuries and their treatments result in severe
pain. Unlike traumatic
injuries that are characterized by a discrete episode of
pain followed by recovery,
burn-injured patients endure
pain for a prolonged period that lasts through
wound closure (e.g. background
pain, procedural pain, breakthrough pain, neuropathic pain and itch).
Regional anesthesia, including peripheral nerve blocks and neuraxial/
epidural anesthesia, offers significant benefits to a multimodal approach in
pain treatment. A 'regional-first' approach to
pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and
pain medicine practitioners in the care of
burn patients. A detailed understanding of peripheral nerve anatomy frames the
burn clinician's perspective when considering a peripheral nerve block/
catheter. The infra/supraclavicular
nerve block provides excellent coverage for the upper extremity, while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks. The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites. Burn centers that adopt
regional anesthesia should be aware of potential complications and
contraindications to prevent adverse events, including management of
local anesthetic toxicity and epidural
infections. Management of anticoagulation around
regional anesthesia placement is crucial to prevent
hematoma and nerve damage. Ultimately,
regional anesthesia can facilitate a better patient experience and allow for
early therapy and mobility goals that are hallmarks of
burn care and rehabilitation.