Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period tha...Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(e.g.background pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter.The infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks.The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites.Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural infections.Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage.Ultimately,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.展开更多
Armed conflicts are increasing globally due to political unrest and the broader effects of climate change.Without resources to provide quality surgical care,it becomes nearly impossible to provide quality emergency su...Armed conflicts are increasing globally due to political unrest and the broader effects of climate change.Without resources to provide quality surgical care,it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries.To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict,a matrix to identify variables and help with interventions was envisioned.Apreviously published global surgery matrix based on the PIPES(Personnel,Infrastructure,Procedures,Equipment and Supplies)surgical capacity tool was adapted to this context.The novel matrix incorporates 108 variables.These variables are grossly divided into local and international agency components to address the issue of who is providing care.Using a time continuum of pre-conflict,conflict,and post-conflict allows organizations to concentrate on when during the conflict to target their intervention.In addition to the previously used personnel,infrastructure,procedures,equipment,and supplies categories,a sixth category called standards was included that addresses the issues such as information technology,data systems,quality improvement programs,and patient safety.Pilot testing of this matrix to obtain feedback from end users is the next step in development.Ultimately,peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.展开更多
文摘Burn injuries and their treatments result in severe pain.Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery,burn-injured patients endure pain for a prolonged period that lasts through wound closure(e.g.background pain,procedural pain,breakthrough pain,neuropathic pain and itch).Regional anesthesia,including peripheral nerve blocks and neuraxial/epidural anesthesia,offers significant benefits to a multimodal approach in pain treatment.A‘regional-first’approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients.A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter.The infra/supraclavicular nerve block provides excellent coverage for the upper extremity,while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks.The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites.Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events,including management of local anesthetic toxicity and epidural infections.Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage.Ultimately,regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.
文摘Armed conflicts are increasing globally due to political unrest and the broader effects of climate change.Without resources to provide quality surgical care,it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries.To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict,a matrix to identify variables and help with interventions was envisioned.Apreviously published global surgery matrix based on the PIPES(Personnel,Infrastructure,Procedures,Equipment and Supplies)surgical capacity tool was adapted to this context.The novel matrix incorporates 108 variables.These variables are grossly divided into local and international agency components to address the issue of who is providing care.Using a time continuum of pre-conflict,conflict,and post-conflict allows organizations to concentrate on when during the conflict to target their intervention.In addition to the previously used personnel,infrastructure,procedures,equipment,and supplies categories,a sixth category called standards was included that addresses the issues such as information technology,data systems,quality improvement programs,and patient safety.Pilot testing of this matrix to obtain feedback from end users is the next step in development.Ultimately,peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.
