Epidural Anesthesia for Pain Relief in Patients With Severe Burns

Patients with severe burn injuries endure intense pain, which is amplified by serial operations, daily dressing changes, and regular physical therapy. While peripheral nerve blocks have become increasingly popular in the management of isolated burns to the extremities, there have been few reports on the use of neuraxial anesthesia to treat burn pain. Here, we describe the inclusion of epidural anesthesia in our algorithm for management of burns to the lower trunk, bilateral lower extremities, buttocks, and perineum. We hypothesized that epidural anesthesia would be associated with reduced opioid use and improved pain scores. We performed a retrospective review of all patients admitted to a verified burn center who underwent epidural catheter placement between 2018 and 2024. Visual analog scale pain scores and opioid consumption (standardized in morphine milligram equivalents [MMEs]) were extracted for several days before and after placement of each patient's first epidural catheter. During the study period, 11 patients underwent epidural catheterization in our burn unit. An average of 1.8 (SD 1.3) catheters were placed per patient, for a total of 20 catheters. All patients experienced significant reductions in daily opioid consumption (92.5 MMEs/day pre-epidural to 58.1 MMEs/day postepidural, P = .008) and average pain scores (6.25 pre-epidural to 2.45 postepidural; P = .008). Minor complications including nausea/vomiting and pruritus occurred in 4 patients. There were no major complications or infections. We conclude that epidural anesthesia is safe and effective for relieving pain and decreasing opioid consumption in patients with burn injuries.