Expert: Dr Ian Jackson - please note UK based - 3/18/2009

Question
QUESTION: Hi:

I've heard that victims of full-thickness burns need for their wounds to scrubbed to prevent infection and to speed up the healing process.

This debridement process is extremely painful. So I ask, why aren't patients anesthetized before their wounds are clean? It so simple, either inject the anesthetic into a nerve, or rub a topical anesthetic on the wound -- or even better -- provide a general anesthetic for the patient, so that he/she will not feel any hint of pain during the wound-cleaning process.

From what I've heard, most burn victims are given pain medications before the would-scraping, but this is hardly enough. They are still in enough pain that they yell and twitch while being cleaned.

So why not anesthetize before cleaning? If I were a burn victim, I'd prefer to be knocked-out cold before the procedure.


Thanks,

Green

ANSWER: Hi there
Interesting question. I have not worked in a burns unit since my training over 20 years ago. Certainly we managed people with burns and did anaesthetitise some of them for cleaning of burns and dressing changes. However this was a minority as it is said that people with full thickness burns have damaged their nerve endings and so feel much less pain and simple analgesics or the use of Entonox was all they required. The question is how are full thickness burns managed and current wisdom is to clean these agressively and then graft at an early stage - ideally within 5 days.
In answer to your question about topical anaesthesia won't work (no nerve endings), local anaesthesia regional block requires a suitable place to inject into which is often not available.
Overall I believe that specialist burn centres work very hard with their patients to manage their pain and do not deliberately try to cause them pain.
kind regards
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Most patients are treated with morphine [or other opiods] prior to wound-scraping.

But why not just give general anesthesia as done with most surgeries?

Answer
Hi there
So many variables as I tried to explain as above. Further complication is that if the burn is over a large area then the patients are nursed in special clean rooms to help prevent infection. These are not suitable for provision of anaesthesia and moving a patient away from these areas to theatre would increase risks quite markedly.
It has been many years since I worked in such a unit and so I cannot comment with authority on what happens currently in the UK.
Kind regards
Dr Ian Jackson