The effectiveness of tumescent anesthesia in managing pain for enzymatic debridement of burns. A case-control study

Introduction: Burn injuries are a global health challenge, causing significant pain, tissue damage and complex wound management issues. Traditional treatments like surgical debridement, while effective, pose challenges such as blood loss, grafting requirements, and prolonged hospital stays. Enzymatic debridement, such as the Nexobrid procedure, effectively removes necrotic tissue but can be painful for patients. This study evaluates the efficacy of tumescent anesthesia with lidocaine (TLA) in managing pain during this procedure.

Methods: This retrospective case-control clinical study was conducted at Cannizzaro Hospital in Catania from January 2023 to January 2024. It included 23 patients aged ≥ 18 years with thermal burns on the trunk or multiple locations, who did not require mechanical ventilation due to other causes. The case group (TLA group) included 10 patients treated with tumescent anesthesia (TLA), while the control group (w/o TLA) included 13 patients managed with standard general/opioid methods. Pain was assessed using the Numeric Pain Scale (NPS) at multiple time points.

Results: Descriptive statistics were calculated for age, TBSA, and pain values measured with the NRS scale for each time interval. In the TLA group, the Friedman One-Way Repeated Measures ANOVA revealed a statistically significant reduction in perceived pain over time (p < 0.001), which was not observed in the control group(p = 0.121). The Mann-Whitney U test indicated a statistically significant difference in pain between the two groups (p < 0.05), with lower pain levels in the TLA group.

Conclusion: TLA effectively manages pain in burn patients undergoing enzymatic debridement.This approach improves patient outcomes and satisfaction by providing effective pain control, minimizing recovery time, and offering a viable alternative to traditional anesthesia methods. Further research with larger, multi-center studies is recommended to validate these findings and establish standardized protocols for TLA in burn care.