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Papers of the Week

2020 Apr 30

J Burn Care Res

Perioperative multimodal analgesia reduces opioid use following skin grafting in non-intubated burn patients.


Lennertz R, Haley Z, McCormick T, Hetzel S, Faucher L, Gibson A
J Burn Care Res. 2020 Apr 30.
PMID: 32353145.


Hundreds of patients are treated for burn injuries each year at University of Wisconsin School of Medicine and Public Health. Pain management is particularly challenging during dressing changes and following skin grafting procedures. We performed a retrospective chart review from January 2011 through June 2018 to evaluate the effect of non-opioid analgesic medications on opioid use in non-intubated patients. Our primary outcome was the change in opioid use following the procedure. We found that most patients (69%) report severe pain (NRS ≥7) immediately after autologous skin grafting. On average, patients required an additional 52 mg of oral morphine equivalents (ME) in the 24 hours after the procedure compared to the 24 hours before. The use of perioperative non-opioid analgesia varied between patients (acetaminophen 29%, gabapentin 29%, ketamine 35% and all three 8%). Patients who received either gabapentin or a combination of acetaminophen, gabapentin and ketamine had a smaller increase in their opioid use than patients who did not receive the medications (-25 ME, 95% CI [-46, -4]; p=0.018 and -47 ME [-81, -11]; p=0.010 respectively). These results support using a combination of acetaminophen, gabapentin and ketamine for perioperative analgesia in burn patients undergoing autologous skin grafting.