{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T20:34:17Z","timestamp":1769459657359,"version":"3.49.0"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Pain management in patients with severe burns remains one of the most complex challenges in perioperative care. Burn-related pain is multifactorial, resulting from tissue destruction, intense inflammation, surgical procedures, and repeated dressing changes. Opioids remain the cornerstone of analgesia; however, prolonged use is associated with tolerance, dependence, adverse effects, and prolonged hospitalization. Multimodal and opioid-sparing strategies, including regional anesthesia, may improve postoperative outcomes by enhancing analgesia while reducing systemic drug exposure. This study aimed to evaluate the effectiveness of a standardized regional anesthesia protocol in reducing postoperative pain and opioid requirements in burn patients undergoing lower-limb escharectomy and autologous skin grafting. Methods: We conducted a retrospective, single-center analysis of 25 adult patients with deep thermal burns of the lower limbs who underwent escharectomy and split-thickness skin grafting. All patients received a combined ultrasound-guided sciatic popliteal block and adductor canal block on both the burned limb and the donor site. Ropivacaine 0.375% with clonidine was administered without exceeding a total dose of 3.0 mg\/kg. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and opioid consumption was recorded as rescue doses in intravenous morphine equivalents. Secondary outcomes included perioperative complications and 30-day hospital readmission. Results: Regional anesthesia provided effective postoperative pain control. Thirty-two percent of patients reported no pain (NRS 0), 52% reported mild pain (NRS 1\u20133), and 16% reported moderate pain (NRS 4\u20136). No patient reported severe pain (NRS 7\u201310). Only four patients (16%) required rescue opioids. No perioperative complications or block-related adverse events occurred, and no patient required hospital readmission within 30 days. Conclusions: In this cohort, regional anesthesia was associated with satisfactory postoperative analgesia and minimal opioid requirements. By reducing opioid exposure, this approach may help improve patient comfort and potentially limit opioid-related adverse effects. Larger prospective studies are needed to confirm these findings and to assess long-term outcomes.<\/jats:p>","DOI":"10.3390\/life16020202","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T10:24:36Z","timestamp":1769423076000},"page":"202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Pain and Opioid Use Following Lower-Limb Escharectomy and Skin Grafting Under a Standardized Regional Anesthesia Protocol: A Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-7393","authenticated-orcid":false,"given":"Francesco","family":"Coppolino","sequence":"first","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6864-6655","authenticated-orcid":false,"given":"Francesco","family":"Coletta","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2088-6317","authenticated-orcid":false,"given":"Pasquale","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9695-5385","authenticated-orcid":false,"given":"Maria Rosaria","family":"Cavezza","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7572-0721","authenticated-orcid":false,"given":"Romolo","family":"Villani","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Schettino","sequence":"additional","affiliation":[{"name":"Emergency Anaesthesia, Burn Intensive Care Unit and Poison Control, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Mataro","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery and Burn Unit, AORN Antonio Cardarelli Hospital, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Scalvenzi","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Aurilio","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-3586","authenticated-orcid":false,"given":"Pasquale","family":"Sansone","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Caterina","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-3388","authenticated-orcid":false,"given":"Vincenzo","family":"Pota","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.cps.2023.11.004","article-title":"Pain Management in Burn Patients: Pharmacologic Management of Acute and Chronic Pain","volume":"51","author":"Klifto","year":"2024","journal-title":"Clin. Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.pmr.2023.06.029","article-title":"Early Mobilization, Early Ambulation, and Burn Therapy in the Acute Hospital Setting","volume":"34","author":"Hines","year":"2023","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.burns.2022.06.018","article-title":"Epidemiology of burn injury and the ideal dressing in global burn care\u2014Regional differences explored","volume":"49","author":"Opriessnig","year":"2023","journal-title":"Burns"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1093\/jbcr\/irad069","article-title":"Regional Anesthesia and Acute Pain Management for Adult Patients with Burns","volume":"44","author":"Wardhan","year":"2023","journal-title":"J. Burn. Care Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s40122-022-00366-0","article-title":"Pain in Intensive Care: A Narrative Review","volume":"11","author":"Pota","year":"2022","journal-title":"Pain Ther."},{"key":"ref_6","first-page":"451","article-title":"Chronic pain in intensive care unit survivors: Incidence, characteristics and side-effects up to one-year post-discharge","volume":"51","author":"Devine","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1056\/NEJMra025411","article-title":"Opioid therapy for chronic pain","volume":"349","author":"Ballantyne","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.cps.2017.02.026","article-title":"Sedation and Pain Management in Burn Patients","volume":"44","author":"Griggs","year":"2017","journal-title":"Clin. Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"329","DOI":"10.2165\/00128071-200001060-00001","article-title":"Treatment of pain in severe burns","volume":"1","author":"Gallagher","year":"2000","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S2352-4642(21)00350-3","article-title":"Management of non-severe burn wounds in children and adolescents: Optimising outcomes through all stages of the patient journey","volume":"6","author":"Cuttle","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.burns.2023.03.006","article-title":"Systematic review of molecular pathways in burn wound healing","volume":"49","author":"Walter","year":"2023","journal-title":"Burns"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"493","DOI":"10.23736\/S2784-8671.23.07497-2","article-title":"Tocilizumab and hyperdynamic syndrome in severe burn patient: Is that pouring water on fire?","volume":"158","author":"Coletta","year":"2023","journal-title":"Ital. J. Dermatol. Venereol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0140-6736(00)79605-X","article-title":"Post-shock metabolic response","volume":"239","author":"Cuthbertson","year":"1942","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Meyer, W.J., Wiechman, S., Woodson, L., Jaco, M., and Thomas, C.R. (2012). Management of pain and other discomforts in burnt patients. Total Burn Care, Elsevier Inc.. [4th ed.].","DOI":"10.1016\/B978-1-4377-2786-9.00064-3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s40122-024-00595-5","article-title":"Efficacy and Adverse Effects of IV Morphine for Burn Pain Management in the Emergency Department: An Observational Study","volume":"13","author":"Coletta","year":"2024","journal-title":"Pain Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.burns.2021.07.018","article-title":"Opioid dependence and treatment outcomes among patients with burn injury","volume":"48","author":"Peluso","year":"2022","journal-title":"Burns"},{"key":"ref_17","unstructured":"Bernard, A., Oyler, D.R., Anglen, J.O., Barrett, M.C., Bhalla, P., Cocanour, C.S., Curtis, E., Brighton, B.K., Dangerfield, P., and Erstad, B.L. (2020). Best Practices Guidelines for Acute Pain Management in Trauma Patients, American College of Surgeons."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.2165\/0003495-200868170-00003","article-title":"Analgo-sedation of patients with burns outside the operating room","volume":"68","author":"Gregoretti","year":"2008","journal-title":"Drugs"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1093\/jbcr\/iraa119","article-title":"American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps","volume":"41","author":"Romanowski","year":"2020","journal-title":"J. Burn. Care Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1093\/jbcr\/irad004","article-title":"State and Future Science of Opioids and Potential of Biased-ligand Technology in the Management of Acute Pain After Burn Injury","volume":"44","author":"Hill","year":"2023","journal-title":"J. Burn. Care Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1056\/NEJMra1800222","article-title":"Opioid Tolerance in Critical Illness","volume":"380","author":"Martyn","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_22","first-page":"202","article-title":"Follow-up after intensive care","volume":"4","author":"Griffiths","year":"2004","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"A10","DOI":"10.1016\/j.burns.2004.08.004","article-title":"Pain management","volume":"30","author":"Patterson","year":"2004","journal-title":"Burns"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Schettino, F., Coletta, F., Sala, C., Tomasello, A., De Simone, A., Santoriello, E., Mainini, M., Cotena, S., Di Bari, S., and Villani, R. (2023). Serratus plane block and erector spinae plane block in the management of pain associated with rib fractures in chest trauma: A brief report from a single-center. Adv. Anesth. Pain Med., 1.","DOI":"10.4081\/aapm.2023.11"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jclinane.2016.10.002","article-title":"The benefits of ultrasound-guided continuous sensory nerve blockade in the setting of burn injury: A case report of bilateral continuous superficial peroneal nerve blockade in a patient with severe sleep apnea","volume":"36","author":"Shick","year":"2017","journal-title":"J. Clin. Anesth."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Perkins, L., Pedroza, G., Soghikian, M., Santorelli, J.E., Haines, L.N., Box, K., Lee, J.G., Gabriel, R., and Finneran, J.J. (2024). Continuous peripheral nerve blocks for burn management: A retrospective study of outcomes and complications in 281 burn patients. Reg. Anesth. Pain Med, 39481877.","DOI":"10.1136\/rapm-2024-105930"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/AJP.0000000000000680","article-title":"Exploring the Role of Regional Anesthesia in the Treatment of the Burn-injured Patient: A Narrative Review of Current Literature","volume":"35","author":"Town","year":"2019","journal-title":"Clin. J. Pain."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.burns.2006.04.019","article-title":"A study of regional nerve blocks and local anesthetic creams (Prilox) for donor sites in patients with burns","volume":"33","author":"Gupta","year":"2007","journal-title":"Burns"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/2\/202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T10:39:06Z","timestamp":1769423946000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/2\/202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["life16020202"],"URL":"https:\/\/doi.org\/10.3390\/life16020202","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}