Ultrasound-Guided Fascia Iliaca Plane Block for the Treatment of Donor Site Pain in the Burn-Injured Patient: A Randomized Control Trial

Abstract

Burn injuries requiring surgical intervention often result in split-thickness skin grafting procedures, with donor skin frequently harvested from the patient’s anterolateral thigh. The donor site is often reported as the primary site of postoperative pain due to the damage sustained to localized nociceptors. A randomized control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient-reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomized to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0–10). During the postoperative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range [IQR] 0–0), compared to the control group median 6 (IQR 4–7) (P < .001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0–4) compared to control group median 4.5 (IQR 2–6) (P = .043). The study findings demonstrated that regional anesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.