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.

中文翻译：

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急性烧伤护理中区域麻醉的技术和策略——叙述性综述

烧伤及其治疗会导致剧烈疼痛。与以随后恢复的离散疼痛发作为特征的创伤性损伤不同，烧伤患者在伤口闭合期间忍受较长时间的疼痛（例如背景疼痛、操作性疼痛、突破性疼痛、神经性疼痛和瘙痒）。区域麻醉，包括周围神经阻滞和椎管内/硬膜外麻醉，为疼痛治疗中的多模式方法提供了显着优势。通过让区域麻醉师和疼痛医学从业者参与烧伤患者的护理，可以将“区域优先”的疼痛管理方法纳入烧伤中心的工作流程。在考虑周围神经阻滞/导管时，对周围神经解剖结构的详细了解构成了烧伤临床医生的观点。锁骨下/锁骨上神经阻滞为上肢提供了极好的覆盖，而躯干可以覆盖多种阻滞，包括竖脊肌平面和腰方肌平面阻滞。下肢的目标是髂筋膜平面和供体和受体部位的坐骨神经阻滞。采用区域麻醉的烧伤中心应了解潜在的并发症和禁忌症，以预防不良事件，包括管理局麻药毒性和硬膜外感染。区域麻醉放置周围的抗凝管理对于预防血肿和神经损伤至关重要。最终，区域麻醉可以促进更好的患者体验，并允许早期治疗和行动目标，这是烧伤护理和康复的标志。