Ultrasound-Guided Regional Anaesthesia In Patients Receiving Split-Skin Grafting For Various Burns With Donor Sites From The Upper Thigh: A Prospective Randomized Study

RELIEVE is a study investigating the role of regional anaesthesia (RA) for reducing pain for patients who require split skin grafting after suffering burn injuries. There are approximately 50,000 burn related hospital admissions per annum in Australia at an economic cost of $230m. This patient cohort may experience neuropathic or nerve pain that is notoriously difficult to treat. This trial will compare current pain practice with the use of RA in patients who have suffered burns and require split skin grafting. This study aims to redefine the way clinicians treat burn pain, and to lay the ground work for further investigation into RA and optimization of care for patients with burn injuries. Aim: To assess the effectiveness of regional anaesthesia as an intervention for treating pain resulting from anterior thigh split skin graft donor sites in patients undergoing burn injury treatment. Objectives: To compare and contrast the outcomes of two patient cohorts receiving split skin grafts for burn related injuries: a. Control group receiving standard intervention for harvest of donor site skin from the anterior thigh as per treating team. b. Cohort receiving a single dose fascia iliaca plane block (FIPB) (incorporating blockade of the femoral nerve and lateral femoral cutaneous nerve of the thigh). Methods Prospective, randomised clinical trial. Following institutional ethical approval, 20 participants will be sourced from the Royal Brisbane and Women’s Hospital acute in-patient burns unit. Written, informed consent will be obtained before patients are enrolled in the study. Patients will only be enrolled if they meet the inclusion criteria, and consent to the study. This study population of 20 patients will be divided into two groups (10 patients in each) with a control and interventional group. Once informed consent is obtained, participants will be randomised into two groups using a random number generator and sealed envelopes. Group one (I) will receive standard opioid administration and surgeon local anaesthetic infiltration as per their treating team. Group two (II) will receive an ultrasound guided single-shot fascia iliaca plane block (FIPB) of 0.375% ropivacaine of 20-30mls to provide donor site analgesia on the day of surgery. All blocks will take place in the designated anaesthetic block room prior to general anaesthetic for split skin graft harvesting. Blocks will be placed by qualified and experienced anaesthetic fellows and consultants under direct ultrasound guidance, employing aseptic technique, and according to standard practice. Patients will be followed up by a study member and data will be collected pertaining to numeric pain scores and opioid requirements daily for 7 days post-procedure or until discharge from hospital if it occurs sooner.