Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting

Introduction: Skin grafting is the commonest surgical procedure performed to cover soft tissue defects. It has been known that the split skin graft donor site is more painful than the recipient site itself. Despite its frequent usage, the donor site preparation and postoperative protocol has not bee...

Full description

Saved in:

Bibliographic Details
Main Author:	Chee Kwan, Kong
Format:	Thesis
Language:	English
Published:	2015
Subjects:	RL Dermatology
Online Access:	http://eprints.usm.my/40334/1/Dr._Kong_Chee_Kwan_%28Plastic_Surgery%29-24_pages.pdf
Tags:	Add Tag No Tags, Be the first to tag this record!

id	my-usm-ep.40334
record_format	uketd_dc
spelling	my-usm-ep.403342020-03-25T09:53:52Z Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting 2015 Chee Kwan, Kong RL Dermatology Introduction: Skin grafting is the commonest surgical procedure performed to cover soft tissue defects. It has been known that the split skin graft donor site is more painful than the recipient site itself. Despite its frequent usage, the donor site preparation and postoperative protocol has not been standardized. Infiltration of lignocaine (or / in addition with bupivacaine) is consistently performed prior to harvesting of skin graft only if done under local anaesthesia. However it is not practiced routinely if skin harvesting was done under general anaesthesia. This prospective study determined the benefit and risk of bupivacaine with epinephrine infiltration before harvesting skin graft under general anaesthesia. Method: Sixty patients admitted to University Malaya Medical Centre (UMMC) from July 2012 to April 2013 who required split skin graft from thigh as part of their management were randomized using online randomization tool into either the infiltration group or no infiltration group. Post-operatively, all the patients were given patient-controlled analgesia (PCA) morphine for at least 24 hours to monitor morphine requirement. The Visual analog scale (VAS) assessment was started after 8 hours postoperatively then continued till 24 hours. Total consumption of patient-controlled analgesia morphine was charted every 4 hours to monitor consumption of opioid analgesia for breakthrough pain. Results: Only 53 of the 60 (88.3%) recruited subjects participated in the research until completion (27 in the infiltration group while 26 in the no infiltration group). No statistical difference in the distribution between gender, age, ethnic group, indication for skin graft and estimated donor size among the two randomized groups. There was significant difference in pain intensity between the two groups from 8 to 20 hours post-operatively (p <0.05). The difference between the two groups on cumulative usage of PCA morphine was also significant from 8 to 16 hours post-operatively. There was no neuro-cardiotoxicity detected in both group of patients. None of the donor sites was infected and all healed completely by one month review. Conclusion: Subcutaneous infiltration of bupivacaine with epinephrine before harvesting of split skin graft under general anaesthesia improved postoperative analgesia and decreased opioid consumption. No sign of any toxicity or wound infection observed. It is a safe procedure in the selected group of patients. Therefore, this technique is strongly recommended to be routinely practised to improve postoperative care of skin graft patients. 2015 Thesis http://eprints.usm.my/40334/ http://eprints.usm.my/40334/1/Dr._Kong_Chee_Kwan_%28Plastic_Surgery%29-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RL Dermatology
spellingShingle	RL Dermatology Chee Kwan, Kong Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
description	Introduction: Skin grafting is the commonest surgical procedure performed to cover soft tissue defects. It has been known that the split skin graft donor site is more painful than the recipient site itself. Despite its frequent usage, the donor site preparation and postoperative protocol has not been standardized. Infiltration of lignocaine (or / in addition with bupivacaine) is consistently performed prior to harvesting of skin graft only if done under local anaesthesia. However it is not practiced routinely if skin harvesting was done under general anaesthesia. This prospective study determined the benefit and risk of bupivacaine with epinephrine infiltration before harvesting skin graft under general anaesthesia. Method: Sixty patients admitted to University Malaya Medical Centre (UMMC) from July 2012 to April 2013 who required split skin graft from thigh as part of their management were randomized using online randomization tool into either the infiltration group or no infiltration group. Post-operatively, all the patients were given patient-controlled analgesia (PCA) morphine for at least 24 hours to monitor morphine requirement. The Visual analog scale (VAS) assessment was started after 8 hours postoperatively then continued till 24 hours. Total consumption of patient-controlled analgesia morphine was charted every 4 hours to monitor consumption of opioid analgesia for breakthrough pain. Results: Only 53 of the 60 (88.3%) recruited subjects participated in the research until completion (27 in the infiltration group while 26 in the no infiltration group). No statistical difference in the distribution between gender, age, ethnic group, indication for skin graft and estimated donor size among the two randomized groups. There was significant difference in pain intensity between the two groups from 8 to 20 hours post-operatively (p <0.05). The difference between the two groups on cumulative usage of PCA morphine was also significant from 8 to 16 hours post-operatively. There was no neuro-cardiotoxicity detected in both group of patients. None of the donor sites was infected and all healed completely by one month review. Conclusion: Subcutaneous infiltration of bupivacaine with epinephrine before harvesting of split skin graft under general anaesthesia improved postoperative analgesia and decreased opioid consumption. No sign of any toxicity or wound infection observed. It is a safe procedure in the selected group of patients. Therefore, this technique is strongly recommended to be routinely practised to improve postoperative care of skin graft patients.
format	Thesis
qualification_level	Master's degree
author	Chee Kwan, Kong
author_facet	Chee Kwan, Kong
author_sort	Chee Kwan, Kong
title	Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
title_short	Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
title_full	Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
title_fullStr	Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
title_full_unstemmed	Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
title_sort	safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2015
url	http://eprints.usm.my/40334/1/Dr._Kong_Chee_Kwan_%28Plastic_Surgery%29-24_pages.pdf
_version_	1747820790998368256

Safe and improved analgesia following bupivacaine with epinephrine infiltration before skin graft harvesting

Similar Items