How to manage pain caused by burn medication?

Managing Pain from Burn Medications and Dressing Changes

For pain caused by burn medications and dressing changes, use titrated short-acting opioids or ketamine as first-line agents, combined with non-pharmacological techniques like cooling and appropriate wound dressings. 1

Pharmacological Management

First-Line Agents for Procedural Pain

• Short-acting opioids are the primary pharmacological choice for managing pain during burn dressing changes and medication application, as this pain is typically short-lasting and intense 1

• Titrated intravenous ketamine should be combined with other analgesics for severe burn-induced pain during procedures, as it effectively limits morphine consumption 1

• Inhaled nitrous oxide is particularly useful when intravenous access is unavailable, especially in adolescent patients 1, 2

Multimodal Analgesia Approach

• All analgesic medications must be titrated based on validated comfort and analgesia assessment scales to reduce risks of under- and overdosing, particularly given the hypermetabolism and capillary leakage that occurs with burns 1

• Acetaminophen or NSAIDs should be administered as adjunctive oral analgesics for baseline pain control 3, 4, 2

• Benzodiazepines can be combined with opiates to enhance procedural pain relief 2

When General Anesthesia is Indicated

• General anaesthesia is an effective option for highly painful injuries or procedures, particularly during extensive wound care 1

• Deep analgesia or general anaesthesia will mostly be required for burn wound care performed in a clean environment 1

Non-Pharmacological Techniques

Cooling Interventions

• Cooling limited burned surfaces improves pain control by affecting the inflammatory cascade and should be combined with pharmacological treatments 1, 3

• Cool burns in adults with <20% TBSA and children with <10% TBSA in the absence of shock, as cooling for 20-40 minutes significantly reduces pain 1

Wound Dressing Strategies

• Covering burns with a fatty substance like Vaseline and appropriate dressings reduces pain by protecting the wound and limiting heat loss 1, 3

• Apply petrolatum-based antibiotic ointment without sulfonamides (polymyxin B or bacitracin) after cooling for superficial wounds 3, 4

• Use non-adherent dressings loosely applied to promote healing and reduce pain during dressing changes 3, 4

Psychological Interventions

• Virtual reality or hypnosis techniques may reduce pain intensity and anxiety during dressing changes for patients without life-threatening injuries 1

• Psychological counseling and coping skills should be incorporated as adjuncts to pharmacological management 5

Critical Considerations

Medication Titration

• Burn injuries trigger inflammation, hypermetabolism, and capillary leakage leading to hypovolaemia, which increases the risk of adverse effects from analgesics and requires careful titration 1

• Alpha-2 receptor agonists are difficult to use in the acute phase due to their haemodynamic effects 1

Timing and Preparation

• Pain from dressing changes is often short-lasting, making short-acting agents more appropriate than long-acting formulations 1

• Written protocols for pain management and regular assessment should be encouraged to optimize outcomes 1

Common Pitfalls

• Avoid prolonged use of external cooling devices (e.g., Water-Jel dressings) to prevent hypothermia risk 1

• Do not delay resuscitation interventions for simple dressing applications 1

• Locoregional anaesthesia techniques may be used when applicable but require appropriate patient selection 1