Topical ropivacaine for analgesia of aplasia cutis congenita in newborns with hereditary epidermolysis bullosa
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LETTER TO THE EDITOR
Topical ropivacaine for analgesia of aplasia cutis congenita in newborns with hereditary epidermolysis bullosa A. Chambelland1 , C. Devos2, F. Casagrande3 and C. Chiaverini1*
Abstract Aplasia cutis congenita (ACC) in patients with hereditary epidermolysis bullosa (EB) is often associated with major pain. We report our experience with using topical ropivacaine during dressing in newborns with ACC. Eight full-term newborns with EB and ACC were hospitalized in a neonatal intensive care unit for severe pain during dressing despite the use of paracetamol, opioids (n = 8) or ketamine (n = 7). Topical xylocaine was poorly tolerated and not effective. Ropivacaine 2 mg/ml was used directly in contact with the ACC, with a maximum 1 mg/kg/day, which enabled care without the child crying. No immediate or late systemic toxicity was observed. Topical ropivacaine 0.2% appears to be an interesting topical analgesic, with good clinical tolerance and rapid action, in newborns with ACC and EB. These data need to be confirmed in a prospective study including pharmacokinetics evaluations. Keywords: Epidemolysis bullosa, Aplasia cutis congenita, Ropivacaine, Pain, Newborn Dear editor, Inherited epidermolysis bullosa (EB) is a group a rare genodermatoses characterized by skin and/or mucosal fragility leading to post-traumatic blisters [1]. Depending on the level of cleavage in the skin, four types are described: simplex, junctional, dystrophic and Kindler EB. Aplasia cutis congenita (ACC), defined by a localized absence of skin at birth, can be associated with all types of EB and is usually localized on the legs. Its exact frequency is not known but seems not negligible, up to 17.8% in patients with dystrophic forms [2]. Healing is often long with residual atrophic scar due to the atrophy of subcutaneous tissue. Management of these wounds is difficult because of severe pain during dressing changes in a complex neonatal context. We report our experience with the use of ropivacaine in 8 full-term children (5 males), mean weight 3038.75 g *Correspondence: chiaverini.c@chu‑nice.fr 1 CRMPR Sud, Department of Dermatology, Université Côte D’Azur, CHU de Nice, Archet 2, 151 route de Saint‑Antoine, 06200 Nice, France Full list of author information is available at the end of the article
with EB (4 simplex forms, 2 junctional, 2 dystrophic) and ACC seen in our reference center between 2010 and 2018. All newborns were hospitalized in a neonatal intensive care unit because of severe pain, feeding difficulties and complex dressing of skin wounds. Clinical data are summarized in Table 1. Despite the use of oral paracetamol, opioids (n = 8) or ketamine (n = 7) associated with non-pharmacological interventions, children still had pain during care especially on ACC areas, with inconsolable crying, permanent contraction of the face and removing of the involved limb. Two had apnea. Topical xylocaine (2%) was poorly tolerated and not completely efficient in the first 3 children treated. We then used ropivacaine (2 mg/m
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