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Weaver P, Brual R, Blair D. Analgesia and Sedation in Critically Ill Patients With Burns. AACN Adv Crit Care 2022; 33:125-129. [PMID: 35657759 DOI: 10.4037/aacnacc2022588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Paige Weaver
- Paige Weaver is Critical Care Pharmacy Resident, Maine Medical Center, Portland, Maine
| | - Rochelle Brual
- Rochelle Brual is Emergency Medicine Pharmacy Resident, Union Hospital, Terre Haute, Indiana
| | - David Blair
- David Blair is Clinical Pharmacy Specialist-Emergency Medicine, Pharmacy Department, Ascension Genesys Hospital, 1 Genesys Parkway, Grand Blanc, MI 48439
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Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns 2020; 46:465-471. [DOI: 10.1016/j.burns.2019.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
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Lin YC, Huang CC, Su NY, Lee CL, Lao HC, Lin CS, Chen CC. Patient-controlled analgesia for background pain of major burn injury. J Formos Med Assoc 2018; 118:299-304. [PMID: 29804733 DOI: 10.1016/j.jfma.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/07/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Studies have suggested that intravenous patient-controlled analgesia (IV-PCA) can be used safely for the treatment of background pain in burn patients. However, no comprehensive protocols have been published. How patient or surgical factors correlate with the amount of opioid consumption remains unclear. The aim of this study is to provide an IV-PCA protocol for alleviating pain for burn injuries, and to assess factors correlated with opioid consumption. METHODS At the Mackay Memorial Hospital, a retrospective analysis from June 27th to October 31st of 2015 was carried out to investigate the use of IV-PCA in relation to the demographic and clinical data of patients who suffered from burn injuries due to a massive explosion of flammable powder. A standardized morphine IV-PCA protocol with rapid escalation was implemented. Variables assessed included age, weight, gender, days of usage, total surface area burned (TBSAB) and operations. RESULTS Among the 23 patients who received IV-PCA for burn pain control, it was noted that the larger the TBSAB and the higher the visual analogue scale (VAS), the more amount of morphine was consumed. Correlations between morphine consumption positively with weight (P < 0.01), female gender (P < 0.01), severity of injury (P = 0.01), and negatively with receiving operations (P = 0.01) were statistically significant. CONCLUSION As the daily morphine consumption was positively correlated with TBSAB, VAS, weight, female gender, the use of our IV-PCA protocol was sufficient in the management of background pain for patients with major burn injury.
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Affiliation(s)
- Ying-Chun Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Chien-Chung Huang
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan.
| | - Nuan-Yen Su
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Chia-Lin Lee
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
| | - Hsuan-Chih Lao
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Shiang Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chuan Chen
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Mackay Medical College, Taipei, Taiwan
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de Jong AEE, Bremer M, Hofland HWC, Schuurmans MJ, Middelkoop E, van Loey NEE. The visual analogue thermometer and the graphic numeric rating scale: a comparison of self-report instruments for pain measurement in adults with burns. Burns 2014; 41:333-40. [PMID: 25262546 DOI: 10.1016/j.burns.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/16/2014] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
Abstract
To evaluate the adequacy of pain management in burn care, pain measurement is essential. The visual analogue thermometer (VAT) and graphic numeric rating scale (GNRS) are frequently used self-report instruments for burn pain. To legitimise their interchangeable use in research and practice, we aimed to compare self-reports obtained by the VAT and GNRS, the ability of the scales to differentiate background from procedural pain, and to compare potential cutpoints. Adults with acute burns (N=319) participated in the study (67% male, mean age 40.3 years (SD 16), mean TBSA 9.9% (SD 10.4). Correlation coefficients between VAT and GNRS were 0.64 and 0.55 for, respectively, morning and afternoon background pain and 0.51 for procedural pain (p<0.01). VAT scores were lower than GNRS scores for all pain types (p<0.01). Both scales could differentiate background from procedural pain: procedural pain was higher (p<0.01). The standardized response mean was moderate (0.518 for VAT and 0.571 for GNRS). Self-reported thresholds for 'unacceptable pain' by GNRS were higher than by VAT (p<0.001). ROC analyses showed that the highest sensitivity was reached for pain score 2 for both scales. The results suggest that the instruments cannot be used interchangeably without taking their differences into account.
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Affiliation(s)
- A E E de Jong
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centres, Beverwijk, The Netherlands.
| | - M Bremer
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Martini Hospital, Groningen, The Netherlands
| | - H W C Hofland
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
| | - M J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Middelkoop
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N E E van Loey
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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Hemodynamic responses to dexmedetomidine in critically injured intubated pediatric burned patients: a preliminary study. J Burn Care Res 2013; 34:311-7. [PMID: 22929526 DOI: 10.1097/bcr.0b013e318257d94a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. After baseline measurements of mean arterial blood pressure and heart rhythm were taken, each patient received a 1.0 µg/kg bolus of Dex followed by an ascending dose infusion protocol (0.7-2.5 µg/kg/hr), with each dose administered for 15 minutes. There was significant hypotension (27±7.5%, average drop in mean arterial pressure [MAP] ± SD), and a decrease in heart rate (HR; 19% ± 7, average drop in HR ± SD). The average HR decreased from 146 beats per minute to 120. No bradycardia (HR < 60) or heart blocks were observed. In three patients, the MAP decreased to <50mm Hg with the bolus dose of Dex. Of the remaining five patients, three patients completed the study receiving the highest infusion dose of Dex (2.5 µg/kg/hr), whereas in 2 patients the infusion part of the study was begun, but the study was stopped due to persistent hypotension (MAP < 50mm Hg). These observations indicate that a bolus dose of Dex (1.0 µg/kg for 10 minutes) and high infusion rates may require fluid resuscitation or vasopressor support to maintain normotension in critically injured pediatric burn patients.
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Abstract
This paper is the thirty-fourth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2011 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Sen IM, Sen RK. Regional anesthesia for lower limb burn wound debridements. ARCHIVES OF TRAUMA RESEARCH 2012; 1:135-6. [PMID: 24396763 PMCID: PMC3876540 DOI: 10.5812/atr.6833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 06/20/2012] [Accepted: 06/27/2012] [Indexed: 11/21/2022]
Affiliation(s)
- Indu M Sen
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Corresponding author: Indu M Sen, Anesthesia and Intensive Care, Institute of Medical Education and Research, Chandigarh, Post box No 1519, PGI Campus, Sector12-A, Chandigarh-160012, India. Tel.: +91-1722726677, Fax: +91-1722726677, E-mail:
| | - Ramesh K Sen
- Department of Orthopedic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
For 2011, approximately 1746 original research articles in burns were published in English in scientific journals. This article reviews those with the most potential impact on for burn therapeutics and outcomes according to the Editor of one of the major journals (Burns) and his colleague. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterisation, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, United States.
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