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KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ

Year 2007, Volume: 15 Issue: 3, 150 - 154, 01.12.2007

Mehmet İlker Bilgiç Mithat Akan Gaye Taylan Çalıkapan Tyafun Aköz

Abstract

Greft donör sahasının iyileşmesi ve komplikasyonlarına ait güncel literatürde oldukça çok sayıda çalışma mevcutken, bu bölgedeki ağrıya yönelik yeterli araştırma bulunmamaktadır. Halbuki, greft donör sahasındaki ağrı, ameliyat sonrası dönemde hastaların birincil şikayetlerinden biri olarak karşımıza çıkabilmektedir. Bu çalışma, ağrının azaltılması için, kısmi kalınlıklı deri grefti donör alanında EMLA kullanımının etkilerini değerlendirmek amacıyla planlandı. Çalışmamızda, çeşitli nedenlerle kısmi kalınlıklı deri grefti ile onarım yapılan hastaların donör alanlarına pansuman olarak antibiyotik ve lidokain-prilokain içeren (Eutectic Mixture Of Local Anesthetics -EMLA) krem emdirilmiş yapışmayan pansuman uygulandı ve pansumanın üzeri şeffaf örtü ile kapatıldı. Bu çalışma, 33.8 yaş ortalamasına sahip 40 hasta ile gerçekleştirildi. Hastalar, EMLA uygulanan I. grup ve kontrol grubu olmak üzere 20'şer kişilik iki gruba ayrıldı. EMLA uygulaması, operasyon sonunda ve operasyonu takip eden 24. saatte gerçekleştirildi.Hastaların ağrı değerlendirmesinde görsel ağrı ölçeği (GAÖ) kullanıldı. Buna ek olarak, enfeksiyon, yara sızıntısı, iyileşme süresi ve lokal reaksiyonlar da takip edildi. Yapılan istatistiksel analizler, EMLA kremi ile yapılan pansumanın greft donör sahasının ağrı yönetiminde ameliyat sonrası 1. günden sonra oldukça etkili olduğunu ortaya koydu.

Keywords

EMlA donör alan ağrısı

References

  • 1. Ablaza VJ, Berlet AC, Manstein ME. An alternative treatment for the split skin graft donor site. Aesth Plast Surg 1997;21:207-209.
  • 2. Akan M, Yıldırım S, Mısırlıoğlu A, et al. An alternative method to minimize pain in the split thickness skin graft donor site. Plast Reconstr Surg 2003;111:2243-2249.
  • 3. Alvarez OM, Mertz PM, Eaglestein WH The effect of occlusive dressings on collagen synthesis and reepithelialization in superficial wounds. J Surg Res 1983;35:142-148.
  • 4. Alvi R, Jones S, Burrows D, et al. The safety of topical anesthetic and analgesic agents in a gel when used to provide pain relief at split skin donor site. Burns 1998;24:54-57.
  • 5. Astra Zeneca US Corporate Site. About EMLA Anesthetic Disc 1/01 Copyright 2000.
  • 6. Briggs M, Nelson EA. Topical agents or dressings for pain in venous leg ulcers. Cochrane Database Syst Rev: 2, 2000.
  • 7. Brown GL, Nanney LB, Griffen J, et al. Enhancement of wound healing by topical treatment with epidermal growth factor. N Engl J Med 1989;321:76-79.
  • 8. Bulmer IN, Duckett AC. Absorption of lignocain through split skin donor sites. Anaesthesia 1985;40:808-809.
  • 9. Butler PE, Eadie P A, Lawlor D, et al. Bupivacaine and Kaltostat reduces post-operative donor site pain. Br J Plast Surg 1993;46:523-524.
  • 10. Cenetoglu S, Ozmen S, Tuncer S, et al. Topical lignocain gel for split-thickness skin graft donorsite pain management. Plast Reconstr Surg 2000;105:2633.
  • 11. Cohen IK, Crossland MC, Garrett A, et al. Topical application of epidermal growth factor on to partial thickness wounds in human volunteers does not enhance reepithelialization. Plast Reconstr Surg 1995;96:251-254.
  • 12. Feldman DL. Which dressing for split thickness skin graft donor sites? Ann Plast Surg 1991;27:288-291.
  • 13. Hyland WT,. A painless donor site dressing. Plast Reconstr Surg 1982;69:703-704
  • 14. Tan ST, Roberts RH, Blake BO. Comparing Duoderm with Scarlet Red in the treatment of split skin graft donor sites. Br J Plast Surg 1993;46:79-81
  • 15. Tan ST, Roberts RH, Sinclair SW. Comparison of Zenoderm with Duoderm in the treatment of split skin graft donor sites. Br J Plast Surg 1993;46:82-84
  • 16. Varghese MC, Balin AK, Carter M et al. Local environment of chronic wounds under synthetic dressings. Arch Dermatol 1986;122:52-57
  • 17. Hagerty RC, Warm H. Primary closure of the split thickness donor site. Plast Reconstr Surg 1990;85:293-294.
  • 18. Hallock GG. The cosmetic split thickness skin graft donor site. Plast Reconstr Surg 1999;104:2286-2288.
  • 19. Wood RJ, Peltier OL, Twomey JA. Management of the difficult split thickness donor site. Ann Plast Surg 1989;22:80-81
  • 20. Owen TD, Dye D. The value of topical lignocain gel in pain relief on skin graft donor sites. CN.Br J Plast Surg 1990;43:480-482.
  • 21. Ramaswamy CN. Topical lignocain gel on skin graft donor sites. Br J Plast Surg 1991;44:157
  • 22. Morris WT, Lamb AM. Painless split donor sites: a controlled double blind trial of Opsite , Scarlet Red and Bupivacaine. Aust N.Z.J. Surg 1990;60:617-620
  • 23. Ernst E, Fialka V. Ice freezes pain ?. A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage 1994;9:56-59
  • 24. Akan M, Misirlioğlu A, Yildirim S et al. Ice application to minimize pain in split thickness skin graft donor site. Aesthetic Plast Surg 2003;27:305-307
  • 25. De Luca M, Cancedda R. Culture of human epithelium. Burns 1992;18:5-10
  • 26. Frattianne R, Papay F, Housini I et al. Keratinocyte allografts accelerate healing of thickness donor sites: applications for improved treatment of burns. J Burn Care Rehabil 1993;14:148-154
  • 27. Holm J, Andren B, Grafford K. Pain control in the surgical debridement of leg ulcers by the use of a topical lidocaine – prilocaine cream, EMLA. Acta Derm Venereol 1990;70:132-136
  • 28. Vanscheidt W, Sadjadi Z, Lillieborg S. EMLA anesthetic cream for sharp leg ulcer debridement: a review of the clinical evidence for analgesic efficacy and tolerability. Eur J Dermatol 2001;11:90-96
  • 29. Essink – Tebbes CM, Wuis EW, Liem KD et al. Safety of lidocaine – prilocaine cream application four times a day in premature neonates:a pilot study. Eur J Pediatr 1999;158:421-423
  • 30. Holst RG, Kristofferson A. Lidocaine – prilocaine cream ( EMLA cream) as a topical anesthetic for the cleansing of leg ulcers. The effect of length of application time. Eur J Dermatol 1998;8:245-247.
  • 31. Enander Malmros I, Nilsen T, Lillieborg S. Plasma concentrations and analgesic effect of EMLA (lidocaine – prilocaine) cream for the cleansing of leg ulcers. Acta Derm Venereol 1990;70:227-230
  • 32. Taddio A, Stevens B, Craig K et al. Efficacy and safety of lidocaine – prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197-1201
  • 33. Juhlin L, Hagglund G, Evers H. Absorption of lidocaine and prilocaine after application of EMLA on normal and diseased skin. Acta Derm Venereol 1989;69:18-22

EFFECTIVENESS OF EMLA IN SPLIT THICKNESS SKIN GRAFT DONOR SITE PAIN MANAGEMENT

Year 2007, Volume: 15 Issue: 3, 150 - 154, 01.12.2007

Mehmet İlker Bilgiç Mithat Akan Gaye Taylan Çalıkapan Tyafun Aköz

Abstract

Although there are many studies on split thickness donor site healing and complications, studies on donor site pain are inadequate. In plastic surgery, donor site pain may be the primary concern of the patient. This study was conducted to evaluate the effects of the use of EMLA on the skin graft donor site to reduce pain. In our study, we applied antibiotic and EMLA cream soaked non adherent dressings which were covered with adherent transparent drape to the split thickness skin graft donor site of the patients . Forty patients with a median age of 33,8 were included in this study. The patients were divided into two groups, with 20 patients in group I to whom EMLA were applied and 20 patients in group II, which was specified as the control group. EMLA was applied on patients at the end of the operation and at the 24th hour postoperatively. Visual analogue scale was used to evaluate the pain of the patients. Additionally, infection, fluid loss, healing time and local reactions were also followed. The statistical analysis showed that dressings with EMLA cream were more effective in reducing the donor site pain after the postoperative 24 hours.

Keywords

EMlA Donor site pain

References

  • 1. Ablaza VJ, Berlet AC, Manstein ME. An alternative treatment for the split skin graft donor site. Aesth Plast Surg 1997;21:207-209.
  • 2. Akan M, Yıldırım S, Mısırlıoğlu A, et al. An alternative method to minimize pain in the split thickness skin graft donor site. Plast Reconstr Surg 2003;111:2243-2249.
  • 3. Alvarez OM, Mertz PM, Eaglestein WH The effect of occlusive dressings on collagen synthesis and reepithelialization in superficial wounds. J Surg Res 1983;35:142-148.
  • 4. Alvi R, Jones S, Burrows D, et al. The safety of topical anesthetic and analgesic agents in a gel when used to provide pain relief at split skin donor site. Burns 1998;24:54-57.
  • 5. Astra Zeneca US Corporate Site. About EMLA Anesthetic Disc 1/01 Copyright 2000.
  • 6. Briggs M, Nelson EA. Topical agents or dressings for pain in venous leg ulcers. Cochrane Database Syst Rev: 2, 2000.
  • 7. Brown GL, Nanney LB, Griffen J, et al. Enhancement of wound healing by topical treatment with epidermal growth factor. N Engl J Med 1989;321:76-79.
  • 8. Bulmer IN, Duckett AC. Absorption of lignocain through split skin donor sites. Anaesthesia 1985;40:808-809.
  • 9. Butler PE, Eadie P A, Lawlor D, et al. Bupivacaine and Kaltostat reduces post-operative donor site pain. Br J Plast Surg 1993;46:523-524.
  • 10. Cenetoglu S, Ozmen S, Tuncer S, et al. Topical lignocain gel for split-thickness skin graft donorsite pain management. Plast Reconstr Surg 2000;105:2633.
  • 11. Cohen IK, Crossland MC, Garrett A, et al. Topical application of epidermal growth factor on to partial thickness wounds in human volunteers does not enhance reepithelialization. Plast Reconstr Surg 1995;96:251-254.
  • 12. Feldman DL. Which dressing for split thickness skin graft donor sites? Ann Plast Surg 1991;27:288-291.
  • 13. Hyland WT,. A painless donor site dressing. Plast Reconstr Surg 1982;69:703-704
  • 14. Tan ST, Roberts RH, Blake BO. Comparing Duoderm with Scarlet Red in the treatment of split skin graft donor sites. Br J Plast Surg 1993;46:79-81
  • 15. Tan ST, Roberts RH, Sinclair SW. Comparison of Zenoderm with Duoderm in the treatment of split skin graft donor sites. Br J Plast Surg 1993;46:82-84
  • 16. Varghese MC, Balin AK, Carter M et al. Local environment of chronic wounds under synthetic dressings. Arch Dermatol 1986;122:52-57
  • 17. Hagerty RC, Warm H. Primary closure of the split thickness donor site. Plast Reconstr Surg 1990;85:293-294.
  • 18. Hallock GG. The cosmetic split thickness skin graft donor site. Plast Reconstr Surg 1999;104:2286-2288.
  • 19. Wood RJ, Peltier OL, Twomey JA. Management of the difficult split thickness donor site. Ann Plast Surg 1989;22:80-81
  • 20. Owen TD, Dye D. The value of topical lignocain gel in pain relief on skin graft donor sites. CN.Br J Plast Surg 1990;43:480-482.
  • 21. Ramaswamy CN. Topical lignocain gel on skin graft donor sites. Br J Plast Surg 1991;44:157
  • 22. Morris WT, Lamb AM. Painless split donor sites: a controlled double blind trial of Opsite , Scarlet Red and Bupivacaine. Aust N.Z.J. Surg 1990;60:617-620
  • 23. Ernst E, Fialka V. Ice freezes pain ?. A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage 1994;9:56-59
  • 24. Akan M, Misirlioğlu A, Yildirim S et al. Ice application to minimize pain in split thickness skin graft donor site. Aesthetic Plast Surg 2003;27:305-307
  • 25. De Luca M, Cancedda R. Culture of human epithelium. Burns 1992;18:5-10
  • 26. Frattianne R, Papay F, Housini I et al. Keratinocyte allografts accelerate healing of thickness donor sites: applications for improved treatment of burns. J Burn Care Rehabil 1993;14:148-154
  • 27. Holm J, Andren B, Grafford K. Pain control in the surgical debridement of leg ulcers by the use of a topical lidocaine – prilocaine cream, EMLA. Acta Derm Venereol 1990;70:132-136
  • 28. Vanscheidt W, Sadjadi Z, Lillieborg S. EMLA anesthetic cream for sharp leg ulcer debridement: a review of the clinical evidence for analgesic efficacy and tolerability. Eur J Dermatol 2001;11:90-96
  • 29. Essink – Tebbes CM, Wuis EW, Liem KD et al. Safety of lidocaine – prilocaine cream application four times a day in premature neonates:a pilot study. Eur J Pediatr 1999;158:421-423
  • 30. Holst RG, Kristofferson A. Lidocaine – prilocaine cream ( EMLA cream) as a topical anesthetic for the cleansing of leg ulcers. The effect of length of application time. Eur J Dermatol 1998;8:245-247.
  • 31. Enander Malmros I, Nilsen T, Lillieborg S. Plasma concentrations and analgesic effect of EMLA (lidocaine – prilocaine) cream for the cleansing of leg ulcers. Acta Derm Venereol 1990;70:227-230
  • 32. Taddio A, Stevens B, Craig K et al. Efficacy and safety of lidocaine – prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197-1201
  • 33. Juhlin L, Hagglund G, Evers H. Absorption of lidocaine and prilocaine after application of EMLA on normal and diseased skin. Acta Derm Venereol 1989;69:18-22
There are 33 citations in total.

Details

Other ID JA59ZP67RU
Journal Section Articles
Authors

Mehmet İlker Bilgiç This is me

Mithat Akan This is me

Gaye Taylan Çalıkapan This is me

Tyafun Aköz This is me

Publication Date December 1, 2007
Published in Issue Year 2007 Volume: 15 Issue: 3

Cite

APA Bilgiç, M. İ., Akan, M., Çalıkapan, G. T., Aköz, T. (2007). KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi, 15(3), 150-154.
AMA Bilgiç Mİ, Akan M, Çalıkapan GT, Aköz T. KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ. turkplastsurg. December 2007;15(3):150-154.
Chicago Bilgiç, Mehmet İlker, Mithat Akan, Gaye Taylan Çalıkapan, and Tyafun Aköz. “KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 15, no. 3 (December 2007): 150-54.
EndNote Bilgiç Mİ, Akan M, Çalıkapan GT, Aköz T (December 1, 2007) KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 15 3 150–154.
IEEE M. İ. Bilgiç, M. Akan, G. T. Çalıkapan, and T. Aköz, “KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ”, turkplastsurg, vol. 15, no. 3, pp. 150–154, 2007.
ISNAD Bilgiç, Mehmet İlker et al. “KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi 15/3 (December 2007), 150-154.
JAMA Bilgiç Mİ, Akan M, Çalıkapan GT, Aköz T. KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ. turkplastsurg. 2007;15:150–154.
MLA Bilgiç, Mehmet İlker et al. “KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ”. Türk Plastik Rekonstrüktif Ve Estetik Cerrahi Dergisi, vol. 15, no. 3, 2007, pp. 150-4.
Vancouver Bilgiç Mİ, Akan M, Çalıkapan GT, Aköz T. KISMİ KALINLIKLI DERİ GREFTİ DONÖR ALAN AĞRISI KONTROLÜNDE EMLA KULLANIMININ ETKİNLİĞİ. turkplastsurg. 2007;15(3):150-4.