The benefits of ultrasound-guided continuous sensory nerve blockade in the setting of burn injury: a case report of bilateral continuous superficial peroneal nerve blockade in a patient with severe sleep apnea

Abstract The management of pain after burn injuries is a clinical challenge magnified in patients with significant comorbidities. Presently, burn pain is treated via a wide variety of modalities, including systemic pharmacotherapy and regional analgesia. Although the latter can provide effective pai...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2017-02, Vol.36, p.62-66
Main Authors: Shick, Vladislav, MD, Lebovitz, Evan E., MD, Conrad, Emerson, MD
Format: Article
Language:English
Subjects:
Airway management
Anesthesia
Anesthesia & Perioperative Care
Anxiety
Burn pain management
Burn treatment
Burns - complications
Burns - therapy
Cardiovascular disease
Case reports
Catheters
Chronic Pain - etiology
Chronic Pain - therapy
Clinical trials
Comorbidity
Consent
Foot Injuries - therapy
Humans
Injuries
Male
Middle Aged
Multimodal analgesia
Narcotics
Nerve Block - methods
Obesity
Obstructive sleep apnea
Pain
Pain Management - methods
Pain Medicine
Patients
Peroneal Nerve - diagnostic imaging
Physical therapy
Skin
Skin Transplantation - methods
Sleep apnea
Sleep Apnea Syndromes - complications
Sleep disorders
Ultrasonic imaging
Ultrasonography, Interventional - methods
Use of regional analgesia to block sensory nerves
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Summary:Abstract The management of pain after burn injuries is a clinical challenge magnified in patients with significant comorbidities. Presently, burn pain is treated via a wide variety of modalities, including systemic pharmacotherapy and regional analgesia. Although the latter can provide effective pain control in patients with burn injuries, it is relatively underused. Furthermore, the development of ultrasound guidance has allowed for novel approaches and sparing of motor nerve blockade with preference toward sensory-specific analgesia that has not been possible previously. This can result in decreased opiate use and shorter latency to initiation of rehabilitation. In this report, we describe a patient with chronic pain, morbid obesity, and severe sleep apnea who presented with uncontrolled pain resulting from a burn injury to the dorsum of his feet. The treatment consisted of multimodal analgesia and placement of bilateral continuous superficial peroneal nerve catheters, as he underwent skin grafting and postprocedural hydrotherapy. This novel approach allowed for sparing of postprocedural opiates with positive clinical results.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2016.10.002