Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients

Karel E Y Claes; Sarah Amar; Henk Hoeksema; Rachel Kornhaber; Alette de Jong; Stan Monstrey; Josef Haik; Erik Biros; Moti Harats

doi:10.1016/j.burns.2021.05.018

Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients

Burns. 2022 May;48(3):555-567. doi: 10.1016/j.burns.2021.05.018. Epub 2021 Jun 5.

Authors

Karel E Y Claes¹, Sarah Amar², Henk Hoeksema³, Rachel Kornhaber⁴, Alette de Jong⁵, Stan Monstrey³, Josef Haik⁶, Erik Biros⁷, Moti Harats⁸

Affiliations

¹ Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium; Ghent Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium. Electronic address: karel.claes@uzgent.be.
² Department of Anaesthesiology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
³ Department of Plastic Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium; Ghent Burn Center, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
⁴ College of Health and Medicine, University of Tasmania, Sydney, Australia; National Burns Center, Sheba Medical Center, Israel.
⁵ Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands.
⁶ College of Health and Medicine, University of Tasmania, Sydney, Australia; National Burns Center, Sheba Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel; Institute for Health Research, University of Notre Dame, Australia.
⁷ College of Medicine and Dentistry, James Cook University, Australia.
⁸ National Burns Center, Sheba Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel; Institute for Health Research, University of Notre Dame, Australia.

PMID: 34686390
DOI: 10.1016/j.burns.2021.05.018

Abstract

Background: Pain associated with surgical or enzymatic burn wound debridement prevents many burn centres from working outside an operating theatre, creating a burden. Alternatives for general anaesthesia to manage pain in burn patients treated with enzymatic debridements, such as regional anaesthesia, have not been studied in detail. This study explores the different possibilities for pain management during a bedside NexoBrid™ procedure.

Material and methods: We performed a single-centre retrospective study that included 82 paediatric, adolescent, and adult patients with deep dermal and full-thickness burns treated bedside with NexoBrid™ under regional or general anaesthesia. Outcome measures were pain during the NexoBrid™ procedure, the safety of the anaesthesia and the NexoBrid™ procedure, logistics of the bedside NexoBrid™ procedure, and time to wound closure.

Results: Forty-three patients in the adult group (43/67, 64%) only presented with burn wounds on one upper or the one or two lower extremities. In 29 of them (29/43, 67%), a NexoBrid™ procedure was performed under regional anaesthesia, which resulted in low pain levels without any adverse events. All seven patients in the paediatric group, where only one upper or one or two lower limbs were involved (7/15, 47%), underwent a NexoBrid™ procedure performed under regional anaesthesia where no adverse events were reported. In these children, the use of regional anaesthesia was associated with a significant decrease in time to wound closure (average treatment effect on the treated = -22.5 days, p = 0.021).

Conclusion: This study highlights that regional anaesthesia administered at the bedside should be the method of choice for pain management during NexoBrid™ procedures because often, it can be adequately and safely performed in all age groups. This approach will reduce the burden on operating theatres. A flow chart has been developed to guide pain management during a NexoBrid™ procedure.

Keywords: Enzymatic debridement; General anaesthesia; Laser Doppler imaging; Pain management; Regional anaesthesia.

MeSH terms

Adolescent
Adult
Anesthesia, General
Bromelains* / therapeutic use
Burns* / surgery
Burns* / therapy
Child
Debridement / methods
Humans
Pain / etiology
Pain Management / methods
Retrospective Studies
Wound Healing

Substances

Bromelains