Ultrasound-Guided Regional Anaesthesia In Patients Receiving Split-Skin Grafting For Various Burns With Donor Sites From The Upper Thigh: A Prospective Randomized Study

INTERVENTION: Following institutional ethical approval, 20 participants will be sourced, written consent will be obtained and they will be randomly divided into two groups (10 patients in each) with a control and interventional group. Group one (I) will receive standard opioid administration and surgeon local anaesthetic infiltration as per their treating team for the treatment of pain associated with split skin graft donor sites taken from the thigh for the treatment of burn related injuries. Group two (II) will receive an ultrasound guided single‐shot fascia iliaca plane block (FIPB) of 0.375% ropivacaine of 20‐30mls to provide donor site analgesia on the day of surgery. The interventional group will receive their FIPB in the designated anaesthetic block room prior to general anaesthetic for split skin graft harvesting. Blocks will be placed by qualified and experienced anaesthetic fellows and consultants under direct ultrasound guidance, employing aseptic technique, and according to standard practice. The Fascia iliaca plane block provides effective pain relief for skin grafts from the proximal thigh by blocking the sensory function of the femoral nerve and the lateral femoral cutaneous nerve of the thigh. Patients will be connected to routine observational monitoring including non‐invasive blood pressure, electrocardiogram and pulse oximetry, in addition to oxygen delivery. Each patient will require intravenous access, and prior to the block performance may require sedation to relax them as required. The block will be administered as follows: • The patient is positioned supine with the ultrasound machine placed on the opposite side so that the operator's line of sight, needle, and the screen is in a straight line. Local anaesthetic will be injected into the surrounding tissue to numb the area. • The ultrasound probe is placed on the proximal thigh just below the inguinal ligament transverse to the anticipated lie of the femoral nerve, artery and vein. • Two fascia layers should be identified – the fascia lata (superficially) and the deeper fascial iliaca (overlying the ilacus muscle and femoral nerve). • Using an in‐plane ultrasound guided technique the block 100mm 22g short bevel block needle is advanced through both fascial layers to lie just beneath the fascia iliaca and above the iliacus muscle lateral to the femoral nerve. • Injection of the local anaesthetic solution is performed between the fascia and deeper muscle layer. The efficacy of the block will then be judged based on the three point sensory and function motor scale. Skin sensation will be assessed, along with functional capacity. CONDITION: Acute Burn Pain PRIMARY OUTCOME: The efficacy of regional anaesthesia will be judged based on rescue analgesia and opioid equivalents. This data will be collected prospectively and through review of medical records. The efficacy of regional anaesthesia will be judged based on the 10 point numeric pain scale. SECONDARY OUTCOME: The efficacy of regional anaesthesia will be judged pre‐operatively by a three point sensory and function motor scale. This scale is routinely utilised in regional anaesthesia assessment and has been employed across a variety of regional anaesthesia studies. It is a known method of assessment, though not a validated tool. INCLUSION CRITERIA: ‐ Patients aged >17 years ‐ General anaesthesia for burn procedures requiring split skin grafting ‐ Patients receiving donor skin from the upper thigh ‐ ASA 1‐3