Can etoricoxib be given to an adult with a superficial (first‑degree or small second‑degree) burn who has no cardiovascular disease, uncontrolled hypertension, renal impairment, active gastrointestinal ulcer, NSAID hypersensitivity, pregnancy, or lactation?

Etoricoxib for Burn Pain Management

Etoricoxib should not be used for burn pain management; instead, use short-acting opioids (such as morphine or fentanyl), ketamine, or inhaled nitrous oxide as recommended by burn management guidelines. 1

Why Etoricoxib Is Not Appropriate for Burns

Guideline-Recommended Analgesics for Burns

The 2020 Anaesthesia guidelines for severe thermal burn management explicitly recommend specific analgesics for burn pain, and NSAIDs (including etoricoxib) are notably absent from these recommendations. 1

The recommended analgesics for burn pain are:

• Short-acting opioids (morphine, fentanyl) - best for burn-induced pain 1
• Titrated intravenous ketamine - effective for severe burn pain and can be combined with other analgesics 1
• Inhaled nitrous oxide - particularly useful when no IV access is available 1
• Multimodal analgesia - all medications must be titrated based on validated pain assessment scales 1

Specific Contraindications in Burn Patients

Burns create a physiological state that makes NSAIDs particularly problematic:

• Hypermetabolism and capillary leakage lead to hypovolaemia, increasing the risk of adverse effects from NSAIDs 1
• Fluid shifts and hemodynamic instability in burn patients make renal toxicity from NSAIDs more likely 1
• Increased bleeding risk is particularly concerning given potential need for surgical debridement or grafting 1

NSAID-Specific Risks Relevant to Burns

Etoricoxib and other NSAIDs carry cardiovascular and renal risks that are amplified in burn patients:

• Cardiovascular thrombotic events - etoricoxib increases risk of MI and stroke, which can be fatal 2
• Renal toxicity - NSAIDs should be discontinued if BUN or creatinine doubles 1
• Gastrointestinal bleeding - occurs in 1% of patients treated for 3-6 months, 2-4% at one year 2
• Fluid retention and hypertension - etoricoxib provokes arterial hypertension, edema, and heart failure 3

Appropriate Pain Management Algorithm for Burns

For Superficial Burns (First-Degree or Small Second-Degree)

Step 1: Initial cooling (if appropriate)

• Cool burns with TBSA <20% in adults or <10% in children if no shock present 1
• Cooling for 20-39 minutes reduces need for skin grafting 1

Step 2: Primary analgesia

• First-line: Short-acting opioids (morphine, fentanyl) titrated to effect 1
• Alternative/adjunct: Ketamine IV, titrated carefully 1
• When no IV access: Inhaled nitrous oxide 1

Step 3: For dressing changes

• Deep analgesia or general anesthesia often required 1
• Non-pharmacological techniques can be combined with analgesics if patient is stable 1

Common Pitfalls to Avoid

Do not use NSAIDs (including etoricoxib) because:

• They are not mentioned in burn management guidelines despite extensive discussion of analgesic options 1
• The physiological derangements of burns (capillary leakage, hypovolemia, hypermetabolism) increase NSAID toxicity risk 1
• Opioids are explicitly stated as "safe and effective alternative analgesics to NSAIDs" in pain management 1

Do not delay analgesia:

• Burn pain is often very intense and difficult to treat 1
• Pain management should use written protocols and regular assessment 1

Context: When Etoricoxib Might Be Considered (Not for Burns)

While etoricoxib is effective for acute postoperative pain (NNT 1.9 for 50% pain relief) 4, chronic arthropathies 5, 6, 7, and dental pain 4, 5, it should be avoided in burn patients due to the specific contraindications outlined above and the availability of superior alternatives recommended by burn management guidelines.