Does topical local anaesthetic change the thickness of burns scars and affect the performance of burns laser in the outpatient setting?
Hugo Loveday1, Andrew Castley1,2, Gabby Pulbrook1, Bec Schrale1, 1Royal Hobart Hospital 2FRACS (Plast)
Abstract
Laser therapy has become a conventional treatment for chronic burns scars for hypertrophy and contracture. Precision is the cornerstone of effective laser therapy and is dependent on a range of factors including the experience and competence of the laser operator and technical features of the laser, and the physical properties of scar tissue. Transient changes in tissue properties could feasibly interfere with this precision, impairing the ability of the laser operator to optimally use the laser. Adult burns services across Australia are performing burns laser under topical local anaesthetic (TLA), which is absorbed by and temporarily accumulates in the skin. Tahir et al (2006) determiend that TLA results in significant temporary changes in the thickness of normal skin, but the literature has not considered whether the same is true where TLA is applied to chronic burns. Are burns scars, which have greater tissue hardness and lower visco-elasticity than normal skin, also be temporarily thickened by TLA? Given the potential implications for operator precision and increasing performance of burns laser in the outpatient setting under TLA, the answer to this question is critical to ensuring that patients undergoing burns laser therapy under TLA enjoy the same quality of care as those being treated under sedation or general anaesthesia. We present a detailed rationale and protocol of a randomized controlled trial currently pending ethics approval for assessment of scar thickness pre and post application of topical local anaesthetic prior to outpatient burns laser.
TAHIR, A., WEBB, J. B., ALLEN, G. & NANCARROW, J. D. 2006. The effect of local anaesthetic cream (EMLA ®) applied with an occlusive dressing on skin thickness. Does it matter? Journal of Plastic, Reconstructive & Aesthetic Surgery, 59, 404-408.
Biography
Dr Hugo Loveday is an unaccredited Plastic Surgery Registrar at the Royal Hobart Hospital, working as part of a mixed adult and paediatric statewide burns service.