[Peripheral regional analgesia with lidocaine in burned patient: case report.]

Regional anesthesia is difficult in burned patients due to the randomized location of thermal injuries. High plasma levels of alpha1-acid glycoprotein with major affinity to basic drugs, especially lidocaine, have been observed in these patients. This report shows how intermittent peripheral regional anesthesia and analgesia with high lidocaine doses may be useful in inducing effective analgesia in patient with almost 20% Total Burn Skin Area (TBSA) of partial thickness burn in his four limbs.

Male patient, 23 years old, 86 kg, physical status ASA II, with superficial facial burn, partial thickness burn on four limbs and increased serum alpha1-acid glycoprotein levels (260 mg.dL-1), who was treated with 11.6 mg.kg-1 lidocaine with 1:400,000 epinephrine through catheters inserted and tunnelized, for several procedures - irrigations and dressing changes, débridements, physical therapy, skin grafting and daily analgesia during 28 days.

Burned patients with thermal injuries on the extremities are suitable for peripheral regional analgesia. High alpha1-acid glycoprotein serum levels and injection site may allow the use of high lidocaine doses.