Topical local anesthetics for pain control at split-thickness skin graft donor sites in burn patients: a systematic review and meta-analysis of randomized controlled trials.

backgroundSplit-thickness skin grafting (STSG) is commonly used in the treatment of burn injuries and extensive skin defects. However, significant postoperative pain frequently occurs at donor sites and may impair patient recovery and postoperative rehabilitation. Topical analgesic interventions have been proposed as an effective strategy for localized pain management while minimizing systemic adverse effects.

objectiveTo systematically evaluate the efficacy and safety of topical analgesic interventions for pain control at donor sites following STSG in burn patients.

methodsA systematic literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to January 2026. Randomized controlled trials comparing topical analgesic interventions with placebo or standard care for STSG donor-site pain were included. The primary outcome was postoperative pain score. Secondary outcomes included incidence of rescue analgesia, time to first rescue analgesia, anesthetic requirement, and adverse events. Meta-analysis was performed using Review Manager (RevMan) version 5.3.

resultsTen randomized controlled trials were included in the analysis. For the primary outcome, no statistically significant difference was observed in postoperative pain scores between topical analgesic interventions and control treatment (MD = - 1.87, 95% CI: -5.05 to 1.31, P = 0.25). For secondary outcomes, topical analgesic interventions significantly reduced the incidence of rescue analgesia (OR = 0.06, 95% CI: 0.01-0.58, P = 0.02). Time to first rescue analgesia and anesthetic requirement were reported by single studies and should therefore be interpreted cautiously; these outcomes suggested prolonged time to first rescue analgesia (MD = 8.56, 95% CI: 7.67-9.45, P < 0.00001) and reduced anesthetic requirements (MD = - 20.61, 95% CI: -31.91 to - 9.31, P = 0.0004). No statistically significant differences were found in nausea (OR = 1.09, 95% CI: 0.36-3.30, P = 0.88) or vomiting (OR = 0.50, 95% CI: 0.16-1.56, P = 0.23).

conclusionTopical analgesic interventions did not significantly reduce postoperative pain scores, which was the primary outcome of this meta-analysis. However, they may reduce the need for rescue analgesia without increasing nausea or vomiting. Because some secondary outcomes were based on single studies, these findings should be interpreted with caution. Further well-designed randomized controlled trials are needed to confirm the clinical benefit of topical analgesia for STSG donor-site pain management.