Challenges in anaesthesia and pain management for burn injuries

Abstract

Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.

The Effect of Music Therapy on Perceived Pain, Mental Health, Vital Signs, and Medication Usage of Burn Patients Hospitalized in the Intensive Care Unit: A Randomized Controlled Feasibility Study Protocol

“…Another new feature of this study is the focus on background pain instead of procedural pain. While background pain is usually lower in intensity, it is of longer duration and may thus alter pain memory in the long-term ( 6 ). This is important, since pain chronification may increase the already higher risks of burn patients in developing mental health impairments, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD), elevated stress levels, depression, and insomnia ( 6 , 67 ).…”

“…While background pain is usually lower in intensity, it is of longer duration and may thus alter pain memory in the long-term ( 6 ). This is important, since pain chronification may increase the already higher risks of burn patients in developing mental health impairments, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD), elevated stress levels, depression, and insomnia ( 6 , 67 ). Especially in times of an ongoing opioid crisis, complementary treatments to pharmacological strategies for pain management in burn patients are needed not only for procedural pain, but also for background pain ( 68 ).…”

“…Pain is a symptom that accompanies burn patients during all phases of treatment and rehabilitation and successful pain management is key to both physical and mental health ( 5 ). In the ICU, the evolution and trajectory of pain in burn patients is difficult to predict, and frequently the pain is intense and persistent ( 6 , 7 ). Pain in burn patients can be categorized according to four types ( 8 ):…”

Manejo del dolor en el paciente adulto con trauma por quemadura

“…Por ejemplo, se describe para el manejo del dolor procedimental el uso de dexmedetomidina en bolo 1 μg/kg, asociado a ketamina en bolo 2 mg/kg y tramadol a 1 mg/kg (12). Es importante indagar por comorbilidades como depresión y ansiedad en el paciente quemado, así como brindarle tratamiento farmacológico para el mismo, puesto que están involucradas en la percepción del dolor (9,17). El papel del microbiota se encuentra aún en estudio, ya que presenta alteraciones consecuencia de las quemaduras, y esto se relaciona al dolor agudo, crónico y a la inflamación, por lo que el uso de probióticos, prebióticos y el trasplante fecal podrían tener valor terapéutico (17).…”

A review series on the management of burns injury

“…The authors of these reviews were chosen based on their extensive experience in the clinical management of burns patients, as well as their expertise in burns research. The current theme issue begins with a historical cover note on burns resuscitation 3 and then includes two articles on recent developments in surgical burns management, 4,5 a detailed review of the techniques and challenges involved in anaesthesia and pain management of burn-injured patients, 6 another on the intensive care management of patients with inhalational injuries 7 and finally a paper on the particular challenges of effective communication during the care of younger patients with burns. 8 The information contained in these articles is up to date and has already been translated into the clinical setting, with dramatic improvement in outcomes for patients with extensive burns that was not imaginable a decade ago.…”