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Published on: November 6, 2019
Anesthetic Practices for Laser Therapy in Pediatric Patients with Hypertrophic Burn Scars: A Retrospective
Nicole C McCoy1, Noah Ashley2, Amanda T Tran3
1Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, 29425, United States.
Insights
Optimizing anesthesia for pediatric laser scar therapy is crucial. Preoperative opioids reduce the need for intraoperative/postoperative pain management, while larger treatment areas increase opioid use and pain.
Area of Science:
- Pediatric Anesthesiology
- Dermatology
- Burn Scar Management
Background:
- Burn injuries significantly impact children, leading to hypertrophic scarring and functional limitations.
- Laser therapy is common for pediatric burn scars, but optimal anesthetic strategies remain undefined.
Purpose of the Study:
- To identify effective anesthetic strategies for pediatric laser scar therapy.
- To correlate anesthetic approaches with patient outcomes, including pain and opioid use.
Main Methods:
- Multicenter retrospective cohort study of 98 pediatric patients undergoing laser scar therapy (2020-2023).
- Analysis of perioperative anesthetic management, opioid administration, pain incidence, and emergence delirium.
- Statistical analysis of factors influencing opioid use and pain, including preoperative opioid use, body surface area treated, and laser type.
Main Results:
- Preoperative opioid administration was linked to an 86% reduction in intraoperative/postoperative opioid needs.
- Increased total body surface area treated correlated with higher odds of opioid use and pain.
- Specific laser types were associated with a 2-fold increase in pain incidence.
- Emergence delirium incidence was low (2.5%).
Conclusions:
- Patient and procedural factors significantly influence pain and recovery in pediatric laser scar therapy.
- Anesthetic management and laser type are key variables impacting outcomes.
- Findings can inform standardized anesthetic guidelines for this patient population.
Abstract:
Burn injuries are a leading cause of death and disability worldwide, disproportionally impacting pediatric patients. Many affected children will develop hypertrophic scarring, limiting activity, restricting range of motion, and negatively impacting psychosocial development. Although laser therapy is a routine treatment for hypertrophic burn scars in children, there is no consensus on the best anesthetic technique. In this multicenter retrospective cohort study, we aimed to identify effective anesthetic strategies that correlated with outcomes for pediatric laser scar therapy. We characterized perioperative anesthetic approaches for pediatric patients with burn scars who were undergoing laser therapy at 2 academic centers from 2020 - 2023. Among 239 encounters for 98 patients, intraoperative/ postoperative opioids were given in 53% of encounters. Preoperative opioid use was associated with 86% lower odds of intraoperative/postoperative opioid administration (OR, 0.14; 95% CI, 0.06-0.34; P < .001). A 2-fold increase in total body surface area treated was associated with a 32% increase in the odds of opioid use (OR, 1.32; 95% CI, 1.11-1.58; P = 0.002) and 23% greater odds of pain (OR, 1.23; 95% CI, 1.05-1.43; P = 0.009) when controlling for other variables. Laser type was associated with a 2-fold higher odds of pain (OR, 2.11; 95% CI, 1.07-4.14; P = 0.030), and the incidence of emergence delirium was low (2.5% of the cohort). Differences in laser type and anesthetic management also varied across institutions, which impacted pain and recovery. These findings uncovered key patient and procedure factors that can inform standardized anesthetic guidelines for pediatric laser scar therapy.
