An Analysis of Regional Blocks During Enzymatic Debridement of Burns

Anacaulase is a mixture of enzymes used for the breakdown of eschar in patients with deep partial- or full-thickness burns up to 20% of the body's surface area. European consensus guidelines recommend regional anesthesia of an isolated extremity undergoing enzymatic debridement, but no North American consensus has been reached. Our practice has shifted from a multimodal pain strategy to utilize regional blocks prior to the application of anacaulase. The purpose of this study was to determine whether the introduction of regional blocks improved pain control in patients receiving anacaulase therapy. This is a single-center retrospective comparative study evaluating all patients who received anacaulase from July 2016 to July 2024. Continuous data was evaluated via the Wilcoxon rank sum test and categorical data was evaluated via the chi-square test of independence. In the prespecified period, 47 patients received anacaulase and were included for analysis. Of the 47 patients, 24 (51.1%) underwent regional block. There were no significant differences in baseline characteristics except lower baseline opioid requirements in the regional block group. Pain scores during anacaulase application were significantly lower in patients that received regional blocks (4.5 vs 7, P = .003). There was no difference in change in opioid requirements or requirement of adjunct medications except for dexmedetomidine requirements (0% vs 78.3%, P < .001). Our data suggest that regional blocks were associated with lower pain scores in burn patients receiving anacaulase therapy but did not result in a change in opioid requirements from baseline. Regional blocks may be an effective strategy in this population to reduce pain from enzymatic debridement, but prospective studies would be warranted.