Anesthetic Practices for Laser Therapy in Pediatric Patients with Hypertrophic Burn Scars: A Retrospective Multicenter Cohort Study

Abstract Burn injuries are a leading cause of death and disability worldwide, disproportionally impacting pediatric patients. Many affected children will develop hypertrophic scarring, limiting activity, restricting range of motion, and negatively impacting psychosocial development. Although laser therapy is a routine treatment for hypertrophic burn scars in children, there is no consensus on the best anesthetic technique. In this multicenter retrospective cohort study, we aimed to identify effective anesthetic strategies that correlated with outcomes for pediatric laser scar therapy. We characterized perioperative anesthetic approaches for pediatric patients with burn scars who were undergoing laser therapy at 2 academic centers from 2020 - 2023. Among 239 encounters for 98 patients, intraoperative/ postoperative opioids were given in 53% of encounters. Preoperative opioid use was associated with 86% lower odds of intraoperative/postoperative opioid administration (OR, 0.14; 95% CI, 0.06-0.34; P < .001). A 2-fold increase in total body surface area treated was associated with a 32% increase in the odds of opioid use (OR, 1.32; 95% CI, 1.11-1.58; P = 0.002) and 23% greater odds of pain (OR, 1.23; 95% CI, 1.05-1.43; P = 0.009) when controlling for other variables. Laser type was associated with a 2-fold higher odds of pain (OR, 2.11; 95% CI, 1.07-4.14; P = 0.030), and the incidence of emergence delirium was low (2.5% of the cohort). Differences in laser type and anesthetic management also varied across institutions, which impacted pain and recovery. These findings uncovered key patient and procedure factors that can inform standardized anesthetic guidelines for pediatric laser scar therapy.