A Comparative Study between Surgical Techniques by Local Excisional Debridement with a Xylocaine Block and Excisional Debridement under General Anesthesia, in Necrotizing Fasciitis

Abstract

Objective: This study aimed to compare the clinical and economic outcomes between excisional debridement with a local xylocaine block (LAD) and excisional debridement under general anesthesia (GAD). Material and Methods: This retrospective medical record review was designed to review records of excisional debridement in necrotizing fasciitis (NF) at Sisaket Hospital from January 1, 2017, to December 31, 2019. Outcome measures were clinical outcomes at the preoperative time (baseline data, door-to-operating room), peri-operative time (operating time, blood loss, number of reoperations), postoperative time (mortality rate, length of stay, pain score, opioid drug use), types of NF, and direct costs of treatment by the provider’s perspective. Descriptive statistics, chi-square and Mann-Whitney U test were used. Results: The results of 245 patients showed that LAD was superior to GAD in terms of door-to-operating room time, lower operating time and blood loss, shorter length of hospital stay and lower cost of treatment. Moreover, the LAD showed a lower postoperative pain score, and less opioid drug use when compared to GAD. There were no significant differences in mortality rate, sites of infection and types of NF. Conclusion: LAD showed better clinical outcomes and lower cost of treatment when compared to GAD in the treatment of NF. Nevertheless, excisional debridement under a LAD could be a choice for small wounds at the lower extremities in hospitals with limited resources, and insufficient numbers of anesthesiologists.

Keywords

• excisional debridement
• general anesthesia
• local anesthesia
• necrotizing fasciitis
• outcome
• xylocaine block