Pain during burn dressing change in children: relationship to burn area, depth and analgesic regimens

Atchison, N.E.; Osgood, Patricia F.; Carr, Daniel B.; Szyfelbein, S.K.

doi:10.1016/0304-3959(91)90009-m

Cited by 101 publications

(48 citation statements)

References 22 publications

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“…A positive relationship between pain scores and body surface area burnt has previously been reported. 4 No such relationship occurred in this study.…”

Section: Pca In Burn Injuries: the Subcutaneous Routecontrasting

confidence: 49%

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Wong

1993

Can J Anaesth

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letter I concerning patient recruitment for clinical research raises some interesting points concerning the time at which informed consent should be obtained and the implications of a "no exclusion" clause in a clinical research protocol.We assume that the protocol was approved by the institutional ethics committee, although this is not stated in the letter. Were the three ocular block techniques for cataract surgery all commonly used? If so, they were not experimental techniques. If these assumptions are correct, the consent given by patients should have been only for collection and analysis of aggregate data for publication. Consent, either verbal or written, to have surgery performed under ocular block would have been obtained at the same time, and we are told that patients were made aware of the study by the surgeon. The informed consent for research, obtained shortly before anaesthesia and surgery, therefore refers to data collection concerning efficacy of the block rather than its performance.We have never encountered a "no exclusion" clause in a study protocol and we are not sure what this could mean. The standard of care provided to patients must never be influenced by their decision to participate or not in a study protocol. Did all patients agree to participate and, if not, did they still have one of the three ocular blocks and their cataract surgery? The decision of the anaesthetist to proceed with the block in the patient described should have been based entirely on clinical criteria. We do not understand how postponement of surgery could have put the study at risk. The request of the patient, through his son, to proceed with the block and surgery was presumably because the patient wanted his vision restored and had nothing to do with the research protocol.If there is a language barrier, the investigator, aided by an interpreter, must be satisfied that the patient understands what is entailed. The essential points to be covered include the reasons for the study, research techniques including randomization, anticipated benefits and consequences, foreseeable risks, maintenance of confidentiality of subjects, anticipated time commitment, and the right to withdraw from the study at any time and without penalty. 2 If the investigator has any doubts about the patient's ability to comprehend, the patient must not be enrolled and this should have no consequences for the patient's medical care.

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“…A positive relationship between pain scores and body surface area burnt has previously been reported. 4 No such relationship occurred in this study.…”

Section: Pca In Burn Injuries: the Subcutaneous Routecontrasting

confidence: 49%

Reply

Wong

1993

Can J Anaesth

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“…As mentioned previously, the inadequate management of analgesia is still very common and it is extremely important to continually reassess the effectiveness of therapy, as well as the use of more aggressive methods [20][21][22][23] .…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Tratamento da dor em queimados

Castro

Leal

Sakata

2013

Rev. Bras. Anestesiol.

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Background and objectives: Despite advances, inappropriate analgesic treatment for burn patients is still seen. The objective of this review was to collect data on pain management in burn patients. Content:We reviewed the mechanisms of pain, burn patient assessment, as well as pharmacological and non-pharmacological treatment. Conclusion: Pain management in burn patients is still a challenge for the multidisciplinary team. Frequent and continuous evaluation of the patient's response is very important due to the various stages that the hospitalized burn patient goes through, as well as a combination therapy with analgesic and non-pharmacological measures. Understanding the complexity of the pathophysiological, psychological, and biochemical changes a burn patient presents is the fi rst step to achieve success in analgesic management.

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“…En pratique clinique, l'hyperalgésie détermine essentiellement l'intensité des douleurs provoquées. Chez le patient brûlé, les douleurs provoquées sont gé-néralement beaucoup plus sévères que la douleur de fond, en particulier chez l'enfant (13). En outre, contrairement à la douleur de fond, les douleurs provoquées ont tendance à s'aggraver en cours d'hospitalisation, avec la répétition des stimulations nociceptives sur le même site, l'apparition de nouveaux foyers douloureux (sites de prélèvement) et l'administration de fortes doses d'opiacés.…”

Section: Douleur Et Hyperalgésie Des Patients Brûlésunclassified

Sédation-analgésie du patient brûlé

Gall

Raynaud

2010

Analgésie Et Sédation en Réanimation

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La brûlure est définie comme une atteinte primitive de la peau, des muqueuses et/ou des tissus sous-jacents par des agents thermiques, chimiques, électriques ou par des radiations. Le patient brûlé est exposé à des douleurs et à une souffrance psychologique intense du fait des lésions, de leur caractère accidentel et de la durée de la prise en charge (1). La réalisation des pansements et les interventions chirurgicales de recouvrement constituent des moments particulièrement critiques qui né-cessitent une majoration importante du traitement antalgique par rapport au traitement de fond. Les dispositifs médicaux invasifs, mais également les zones cutanées en voie d'épidermisation peuvent représenter une menace pour la sé-curité des patients agités. La sédation-analgésie occupe donc une place importante dans la prise en charge des patients brûlés avec des objectifs communs aux autres situations de réani-mation traitées dans cet ouvrage et des objectifs spécifiques qui seront envisagés plus en détail ici. Particularités cliniques des patients brûlésLa population des patients brûlés nécessitant la suppléance d'une fonction vitale en réanimation a été redéfinie en 2007, à l'occasion de la publication des décrets relatifs au traitement des grands brûlés (tableau I) (2). Conséquences physiologiques et pharmacologiques de la brûlureLa brûlure est responsable d'une fuite plasmatique et d'une altération de la perméabilité vasculaire dont témoigne la constitution rapide d'oedèmes non seulement dans les tissus brûlés, mais également dans les tissus sains non brûlés.

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Pain during burn dressing change in children: relationship to burn area, depth and analgesic regimens

Cited by 101 publications

References 22 publications

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Sédation-analgésie du patient brûlé

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