Principles of Burn Pain Management

This article describes pathophysiology of burn injury–related pain and the basic principles of burn pain management | Clinics in Plastic Surgery

The focus is on concepts of perioperative and periprocedural pain management with extensive discussion of opioid-based analgesia, including patient-controlled analgesia, challenges of effective opioid therapy in opioid-tolerant patients, and opioid-induced hyperalgesia. The principles of multimodal pain management are discussed, including the importance of psychological counseling, perioperative interventional pain procedures, and alternative pain management options. A brief synopsis of the principles of outpatient pain management is provided.

Full reference: James, D.L. & Jowza, M. (2017) Principles of Burn Pain Management. Clinics in Plastic Surgery. Published online: 15 July 2017

Parents’ reactions can lessen or worsen pain for injured kids

New research (yet to be published) has looked at family coping and distress during a dressing change following a burn injury in kids | The Conversation

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The 18-month study observed 92 families during their young child’s (one to six years) first burn dressing change at a Brisbane hospital.

Parents who reported they were more anxious or distressed were less able to support their child during the procedure. This decreased the child’s ability to cope and increased the child’s distress, which was measured by their ability to be distracted by toys and conversation, compared to crying or screaming during the dressing change.

Ratings of child anxiety and pain during the dressing change were also greater for children of parents who were less able to support their child during the dressing change.

Read the full blog post by  Erin Brown & Justin Kenardy here

Fluid resuscitation management in patients with burns: update

Guilabert, P. et al. (2016) British Journal of Anaesthesia. 117 (3). pp.284-296.

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Image source: LeoCarbajal – Wikipedia // CC BY-SA 3.0

Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the ‘goal-directed therapy’ concept, and the development of new colloid and crystalloid solutions.

Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns?

To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.

Read the abstract here