Analgesic protocol for procedural pain treatment of second-degree burns in children

Aleksandar Komarčević; Radoica Jokić; Miloš Pajić; Mladen Jovanović; Marina Milenković

doi:10.2298/VSP220305043K

Aleksandar Komarčević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Radoica Jokić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Miloš Pajić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Mladen Jovanović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Marina Milenković University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP220305043K

Keywords: analgesics, anesthetics, local, burns, child, pain measurement

Abstract

Background/Aim. Children with burns are submitted to multiple painful and anxiety-related procedures during the change of wound dressing, treatment, and rehabilitation. The objective of analgesic treatments for procedural pain is the safe and efficient management of pain and emotional stress, which requires a careful, balanced, and systematic approach. The aim of this study was to determine the effec-tiveness of analgesic and/or local anesthetic in relieving the intensity of procedural pain. Methods. The study included 120 pediatric patients with second-degree burns who were allocated into four groups of 30 children (control group, groups I, II, and III). During the change of wound dress-ings, children in the control group did not receive any anal-gesics, while in the remaining three groups, 30 minutes prior to the change of wound dressing, oral nonsteroidal anti-inflammatory drug (group I), local anesthetic (group II), or both medications (group III) were administered. Results. The average visual analog scale (VAS) score for assessing pain was statistically significantly higher in the control group on all tested days compared with children in the other three treated groups. On the first test day (24 hrs after sustaining the burn injuries), all children had high VAS scores, and ac-cording to the receiver operating characteristics (ROC) analysis, the boundary value was 89.50/100. There was a remarkable difference in the VAS score between the groups on the fifth day of dressing change with the boundary value of 57.50/100 and on the seventh day when the boundary value was 43.50/100. Children who experienced the lowest intensity pain during dressing changes of burn wounds for all test days were those from the group who received both systemic analgesic and local anesthetic. Conclusion. The study confirmed the importance of introducing the complex polymodal protocol in treating procedural pain in second-degree burns. The protocol should include analgesics as well as anesthetics since they both contribute to achieving the best results in pain reduction and treatment outcomes.

References

1. van der Heijden MJE, de Jong A, Rode H, Martinez R, van Dijk M. Assessing and addressing the problem of pain and distress during wound care procedures in paediatric patients with burns. Burns 2018; 44(1): 175‒82.

2. van der Heijden MJE, Jeekel J, Rode H, Cox S, van Rosmalen J, Hunink MGM, et al. Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial. Burns 2018; 44(4): 823‒33.

3. Nosanov LB, Brandt JL, Schneider DM, Johnson LS. Pain management in burn patients. Curr Trauma Rep 2020; 6: 161–73.

4. Le May S, Hupin M, Khadra C, Ballard A, Paquin D, Beaudin M, et al. Decreasing Pain and Fear in Medical Procedures with a Pediatric Population (DREAM): A Pilot Randomized Within-Subject Trial. Pain Manag Nurs 2021; 22(2): 191‒7.

5. Shahi N, Meier M, Phillips R, Shirek G, Goldsmith A, Recicar J, et al. Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm? J Burn Care Res 2020; 41(4): 814‒9.

6. Chu H, Sen S. Pre-attendance analgesia advice for small acute paediatric burns in the British Isles: A National Survey. Burns 2020; 46(6): 1318‒9.

7. Wall SL, Clarke DL, Nauhaus H, Allorto NL. Barriers to adequate analgesia in paediatric burns patients. S Afr Med J 2020; 110(10): 1032‒5.

8. Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med 2020; 29(3): 365‒74.

9. Baghele A, Dave N, Dias R, Shah H. Effect of preoperative education on anxiety in children undergoing day-care surgery. Indian J Anaesth 2019; 63(7): 565‒70.

10. Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. Acta Biomed 2018; 89(6‒S): 6‒16.

11. Sorge RE, Strath LJ. Sex differences in pain responses. Curr Opin Physiol 2018; 6: 75‒81.

12. Mogil JS. Qualitative sex differences in pain processing: emerging evidence of a biased literature. Nat Rev Neurosci 2020; 21(7): 353‒65.

13. Khan A, Parikh M, Minhajuddin A, Williams T, Abrams R, Kandil E, et al. Opioid prescribing practices in a pediatric burn tertiary care facility: Is it time to change? Burns 2020; 46(1): 219‒24.

14. Wall SL, Clarke DL, Allorto NL. A comparison of analgesia requirements in children with burns: do delayed referrals require higher procedural analgesia doses? Burns Open 2020; 4(3): 103‒9.

15. Jeffs D, Dorman D, Brown S, Files A, Graves T, Kirk E, et al. Effect of Virtual Reality on Adolescent Pain During Burn Wound Care. J Burn Care Res 2014; 35(5): 395–408.

16. Wall SL, Clarke DL, Allorto NL. Analgesia protocols for burns dressings: challenges with implementation. Burns 2019; 45(7): 1680‒4.

17. Abid S, Hussain T, Nazir A, Khenoussi N, Zahir A, Riaz S. Development of nanofibers based neuropathic patch loaded with Lidocaine to deal with nerve pain in burn patients. 2018 IOP Conf Ser: Mater Sci Eng 2018: 414 012019.

18. Van Straten A, Murray AA, Levin AI. Xylocaine® 10% pump spray as topical anaesthetic for venepuncture pain. South African J Anaesth Analg 2018; 24(3): 75–8.

19. Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019; 24(8): 509–21. (English, -french)

20. Barbagallo M, Sacerdote P. Ibuprofen in the treatment of children's inflammatory pain: a clinical and pharmacological overview. Minerva Pediatr. 2019; 71(1): 82‒99.

21. Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23(1): 1‒10.

22. Resch A, Staud C, Radtke C. Nanocellulose-based wound dressing for conservative wound management in children with second-degree burns. Int Wound J 2021; 18(4): 478–86.