b6afae84a3e6b18a7475faa2b08fb314  jcm-14-01571.pdf
565fa06be7aedae86f1f9283bbc5996d3e3839ac  jcm-14-01571.pdf
6798ebb3e274a0dfb4395dc5a0043d428f636de5a3ca5e40f7a3efedc86ef103  jcm-14-01571.pdf

Title:           Pain Management in Burned Patients Treated with Bromelain-Based Enzymatic Debridement
Subject:         Background/Objectives: Enzymatic debridement with bromelain is a treatment option for deep partial thickness and full thickness burns. This procedure is associated with significant pain, necessitating the use of anesthesia techniques. However, there is limited evidence on the optimal strategy to achieve effective pain control. To detail the anesthetic approach in patients undergoing bromelain-based enzymatic debridement for burn injuries. Methods: A retrospective observational study was conducted by analysing the medical records of burn patients treated with enzymatic debridement using bromelain. The study included patients admitted to the Burn Unit of Vall d’Hebron University Hospital between January 2015 and December 2019. Results: A total of 112 patients met the inclusion criteria. The average burned total body surface area (TBSA) was 10.7%  11.4, and the median Abbreviated Burn Severity Index (ABSI) was 5 (range: 2–12). The most commonly burned and treated regions were the upper limbs (73%), followed by the lower limbs (30%) and the abdomen (8%). Regional anesthesia was the predominant technique, utilised in 96% of cases. Among these, axillary nerve block was performed in 47% of patients, with continuous catheter placement in 31%. Pain control was achieved in 61% of patients during the first 48 h following enzymatic debridement. Opioids were required for post-procedure pain relief in 12.5% of cases, and repeat anesthesia was necessary in 2.7%. There was no significant difference in pain management outcomes between single nerve blocks and catheter-based approaches (p = 0.809). Complications were reported in nine patients and included hypotension, nausea, and urinary retention. Conclusions: Bromelain-based enzymatic debridement is a painful intervention requiring specialised anesthetic management. Regional anesthesia techniques offer a safe and effective strategy for pain control, though achieving optimal analgesia during the initial 48 h remains a clinical challenge.
Keywords:        burn; pain; bromelain; enzymatic debridement
Author:          Michelle Laurens Acevedo, Gemma M. Usua and Juan P. Barret
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 Date: 2025-04-08 02:07:46 CEST
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      Title: Patients and Methods 
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        Title: Procedure Description 
        Destination: subsection.2.1
       Item: 
        Title: Outcome Measurement 
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        Title: Statistical Analysis 
        Destination: subsection.2.3
       Item: 
        Title: Ethical Considerations 
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      Title: Results 
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     Item: 
      Title: Discussion 
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     Item: 
      Title: Conclusions 
      Destination: section.5
     Item: 
      Title: References
      Destination: section.6
   Info: 
    Title: Pain Management in Burned Patients Treated with Bromelain-Based Enzymatic Debridement
    Author: Michelle Laurens Acevedo, Gemma M. Usua and Juan P. Barret
    Subject: Background/Objectives: Enzymatic debridement with bromelain is a treatment option for deep partial thickness and full thickness burns. This procedure is associated with significant pain, necessitating the use of anesthesia techniques. However, there is limited evidence on the optimal strategy to achieve effective pain control. To detail the anesthetic approach in patients undergoing bromelain-based enzymatic debridement for burn injuries. Methods: A retrospective observational study was conducted by analysing the medical records of burn patients treated with enzymatic debridement using bromelain. The study included patients admitted to the Burn Unit of Vall d’Hebron University Hospital between January 2015 and December 2019. Results: A total of 112 patients met the inclusion criteria. The average burned total body surface area (TBSA) was 10.7%  11.4, and the median Abbreviated Burn Severity Index (ABSI) was 5 (range: 2 12). The most commonly burned and treated regions were the upper limbs (73%), followed by the lower limbs (30%) and the abdomen (8%). Regional anesthesia was the predominant technique, utilised in 96% of cases. Among these, axillary nerve block was performed in 47% of patients, with continuous catheter placement in 31%. Pain control was achieved in 61% of patients during the first 48 h following enzymatic debridement. Opioids were required for post-procedure pain relief in 12.5% of cases, and repeat anesthesia was necessary in 2.7%. There was no significant difference in pain management outcomes between single nerve blocks and catheter-based approaches (p = 0.809). Complications were reported in nine patients and included hypotension, nausea, and urinary retention. Conclusions: Bromelain-based enzymatic debridement is a painful intervention requiring specialised anesthetic management. Regional anesthesia techniques offer a safe and effective strategy for pain control, though achieving optimal analgesia during the initial 48 h remains a clinical challenge.
    Keywords: burn; pain; bromelain; enzymatic debridement
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