Background Topical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use. Methods Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented. Results There were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels. Conclusions Topical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.

中文翻译：

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供区创面局部麻醉或镇痛的系统文献综述。

背景 局部局部镇痛剂和麻醉剂已在收获前和收获后立即用于裂层皮肤移植 (STSG) 供体部位伤口 (DSW)。没有系统评价它们在提供收获后镇痛方面的有效性，或全身吸收可能的毒性作用。本研究旨在解决哪种药物（如果有的话）比其他药物更受青睐以及是否有任何关于其使用的安全数据的问题。方法 对应用于 STSG DSW 的局部药物的随机对照试验进行系统文献回顾，以提供镇痛作用。通过搜索 Cochrane 和 EBSCO 数据库确定的研究。没有语言或出版年份的限制。主要结果：（清醒）STSG 时的疼痛和收获后的疼痛（直到第一次换药）。次要结果是相对于已发表的毒性剂量数据的血清药物水平。用于评估纳入研究的 Cochrane 偏倚风险评估工具。至少有 2 名评审员筛选和评审了纳入的研究。介绍了叙述性评论。结果 有 11 项研究符合纳入标准。总体方法学质量和患者人数都很低。收获前利多卡因和丙胺卡因的局部低共熔混合物在清醒 STSG 收获中提供了良好的局部麻醉。局部布比卡因（5 项研究）或利多卡因（1 项研究）的收获后麻醉/镇痛效果明显优于安慰剂。外用吗啡的效果并不比安慰剂好。报告剂量的局部麻醉剂均远低于毒性血清水平。结论 局部麻醉剂（利多卡因或布比卡因）在 STSG 收获期间和之后提供良好的镇痛作用，远低于毒性血清水平，但没有确定最佳局部麻醉剂使用的良好数据。没有证据表明吗啡的效果优于安慰剂。