555 Pain Management During Bromelain-Based Enzymatic Debridement in a U.S. Adult Burn Center

Abstract Introduction Outside the United States, bromelain-based enzymatic debridement (BBED) has become an effective tool for removal of burn eschar. BBED can be performed at bedside and allows complete eschar with maximal dermal preservation markedly reduced blood loss. It may also decrease need autografting or amount autograft required. A primary concern is that it a painful procedure requiring appropriate analgesia. Experience in U.S. been gained through multicenter phase 3 clinical trial (DETECT) expanded access treatment protocol (NEXT). In this retrospective study, we describe our experience using BBED, particular focus on pain management. Methods review was conducted 29 adult patients enrolled DETECT NEXT trials who underwent acute deep partial- full-thickness thermal wounds major center between November 2016 July 2022. Patient demographics procedural characteristics, including management strategies Numerical Pain Rating Scale (NPRS) scores before, during, after debridement, were analyzed described. Results Twenty-nine average age 41.2 years (SD=17.8, range 18-72) TBSA 6.3% (SD=5.6, 1-24.5) total BBED. For control during 6 required conscious sedation (CS), 7 regional block (RB), 5 local (LB), 9 only IV oral (IVPO) medications. Two intubated sedated prior to procedure. No patient additional all achieved >95% removal. The NPRS score 24 hours before treatment, 4.0, 4.6, & 4.4, respectively (P=0.65). Sixteen (55%) healed without autografting. number days from wound closure 34.9 (SD=11.9) 40.1 (SD=12.3). Conclusions With analgesia, possible perform burns significant changes patient-reported scores. Prior critical establish logistics reasonable expectations. Applicability Research Practice authors their controlling associated