American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion and Next Steps

Romanowski, Kathleen S; Carson, Joshua; Pape, K; Bernal, Eileen; Sharar, Sam R.; Wiechman, Shelley A.; Carter, Damien; Liu, Yuk Ming; Nitzschke, Stephanie; Bhalla, Paul; Litt, Jeffrey; Przkora, René; Friedman, Bruce; Popiak, Stephanie; Jeng, James C.; Ryan, Colleen M; Joe, Victor

doi:10.1093/jbcr/iraa120

Cited by 21 publications

(18 citation statements)

References 10 publications

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“… 10 Burn injury is widely considered one of the most painful injuries that a person can sustain. 11 A secondary analysis of the 1992 to 1999 data of patients with burns showed opioids were the most commonly used analgesics for all years studied. 12 Tyson et al reported the commonest operative procedures done were skin grafting and debridement, accounting for 46.7% and 42.8% of all operative cases, respectively.…”

Section: Introductionmentioning

confidence: 99%

Clinical Profiles and the Outcomes of Burn Patients Admitted to the Burn Unit of Jimma Medical Center

Mulugeta¹,

Alemayehu²,

Gerema³

2021

CCID

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Background: Burn is a serious public health problem and a leading cause of disability and disfigurement. However, there was no published study from our Hospital Burn Unit that assessed the clinical profiles and the outcomes of burn patients. Objective: This study was aimed to assess the clinical profiles and the outcomes of patients admitted with burn injuries. Methods: Hospital-based retrospective cross-sectional study was conducted at the Burn Unit of JMC. Systematic random sampling was used to include the burn patients. Data were analyzed using SPSS version 25. Descriptive statistics, chi-square (χ 2 ), and student-t-test were performed to describe and assess the relationships between the variables. Multivariate logistic regression was performed to determine the factors affecting the length of hospital stays. Results: One hundred twenty-four burn patients (51.6% female) were included. The majority (79.84%) of the patients were in the age category of less than 29 years. Scalds (47.6%) were the most common cause of burns with three times in females. The extremities (93.5%) were the most frequently affected areas. Patients with second-degree superficial burns accounted for 61.3% of all patients. In 95.88% of the patients, the total body surface area burn (TBSA) was below 20%. Lactated ringers (69.4%) and tramadol (71.0%) were the most frequently used IV fluid for resuscitation and analgesic agent for pain, respectively. Patients who undergo any of the surgical procedures stayed in the hospital for greater than 30 days more than 4 times likely (OR = 4.8, 95% CI 2.08-11.2, P < 0.001). Conclusion: Scalds are the most common cause of burn injury, particularly in patients aged less than 14 years. Educating the community about the risk groups, household safety precautions, and early seeking medical care may reduce the incidence and morbidity of burn injuries.

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Section: Introductionmentioning

confidence: 99%

Clinical Profiles and the Outcomes of Burn Patients Admitted to the Burn Unit of Jimma Medical Center

Mulugeta¹,

Alemayehu²,

Gerema³

2021

CCID

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“…and voltage sensitive calcium channels ( MAANI CV, 2011). In contrast, remifentanil , despite being safe and effective both as an adjuvant and as a monotherapy, has been shown to be highly associated with the development of OIH, regardless of dose ( ROMANOWSKI KS, 2020).…”

Section: Hyperalgesia and Tolerance In The Major Burn Patientmentioning

confidence: 96%

“…As an unintended consequence of this inefficient management, a significant number of patients have survived serious injuries and face intense pain that is very difficult to treat throughout the healing process and hospital stay. (EMERY MA, 2019) Pain is defined by the International Association for the Study of Pain (IASP) as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage" being corroborated by the World Health Organization ( ROMANOWSKI KS , 2020). Therefore, it is important to see pain as a deep, complex and multifaceted phenomenon that has subjective, physiological and psychosocial pillars.…”

Section: The Multifactorial Nature Of Burn Painmentioning

confidence: 99%

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The complexity of major burn pain, tolerance and opioid-induced hyperalgesia: a narrative review

Andrade¹,

Ferreira²,

Filippi³

2022

JHS

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Analgesia for burn patients is often prescribed with opioids at significantly longer and longer doses and durations than analgesic dosing guidelines suggest. However, many patients remain without pain relief. There is also a high risk of developing dependence and opioid use disorder such as hyperalgesia and tolerance. In addition, acute metabolic changes, exacerbated inflammatory cascades, and fluid changes associated with major thermal injuries create significant changes in the volume of distribution and pharmacokinetics of opioids in burn patients. Given these individual and unpredictable variables for each patient and the limited therapeutic windows of these agents, it is evident that pain and opioids require continuous assessment and adjustments for safe and effective pain control in this population, based on dose-response.

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“…10 The combination of alternative methods and conventional drug therapies allows clinicians to maintain adequate pain management while limiting dosages and side effects of pharmaceuticals. 10,13…”

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confidence: 99%

Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain: A Systematic Review

Gasteratos

Papakonstantinou

Man

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions—hypnosis, virtual/augmented reality, and yoga—as supplements to conventional pain regimens for burn management. Methods: A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. Results: The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors’ inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process. Conclusions: Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.

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American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion and Next Steps

Cited by 21 publications

References 10 publications

Clinical Profiles and the Outcomes of Burn Patients Admitted to the Burn Unit of Jimma Medical Center

Clinical Profiles and the Outcomes of Burn Patients Admitted to the Burn Unit of Jimma Medical Center

The complexity of major burn pain, tolerance and opioid-induced hyperalgesia: a narrative review

Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain: A Systematic Review

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