Analgetski protokol u ublažavanju proceduralnog bola kod dece sa opekotinama drugog stepena
Sažetak
Uvod/Cilj. Deca sa opekotinama su tokom previjanja, nege i rehabilitacije podvrgnuta višestrukim, bolnim procedurama koje izazivaju anksioznost. Primena analgetika za ublažavanje proceduralnog bola, ima za cilj bezbedno i efikasno upravljanje bolom i emocionalnim stresom, što zahteva pažljiv, balansiran i sistematičan pristup. Cilj rada bio je da se utvrdi u kojoj meri primena analgetika i/ili lokalnog anestetika ima uticaj na smanjenje intenziteta proceduralnog bola. Metode. U studiju je uključeno 120 pacijenata dečijeg uzrasta sa opekotinama drugog stepena koji su razvrstani u četiri grupe od po 30 dece (kontrolnu grupu i grupe I, II i III). Tokom previjanja, deca iz kontrolne grupe nisu primala analgetike, a deca u preostalim grupama su 30 minuta pre previjanja primali: nesteroidni antiinflamatorni lek, oralno (grupa I), lokalni anestetik (grupa II) ili oba leka (grupa III). Rezultati. Prosečni skor vizuelno analogne skale (VAS) za procenu intenziteta bola bio je statistički značajno veći u kontrolnoj grupi, tokom svih ispitivanih dana, u odnosu na preostale tri grupe dece koje su primile analgetike. Prvog dana (24 časa nakon zadobijanja opekotina), sva deca su imala visoke vrednosti VAS skora i prema receiver operating characteristics (ROC) analizi granična vrednost bila je 89,50/100. Vidna razlika između grupa u pogledu vrednosti VAS skora uočena je petog dana previjanja, sa graničnom vrednosti od 57,50/100 i sedmog dana kada je granična vrednost iznosila 43,50/100. Najmanji intenzitet bola prilikom previjanja, tokom svih ispitivanih dana, prijavljivala su deca u grupi koja je primila i sistemski analgetik i lokalni anestetik. Zaključak. Istraživanje je pokazalo značaj uvođenja složenog polimodalnog protokola u lečenju proceduralnog bola prilikom previjanja opekotina parcijalne debljine kože. Najbolji rezultati u smanjenju intenziteta bola i izlečenju postižu se primenom protokola koji uključuje i sistemsku analgeziju i lokalnu anesteziju.
Reference
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.