Adjuvant Analgesia for acute burns pain

Fiona  Woods3, Kristine Owen1, Edward  Raby2

1Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, 2MSc Fiona Stanley Hospital, 3Burns Service of Western Australia, Burn Injury Research Unit University of Western Australia

Abstract:
Background

Acute burn injury is associated with pain, which may be severe, complex and become chronic. Acute pain management can minimise this progression and a multimodal analgesia pathway including opioid-sparing adjuvants is recommended.(Schug S, 2015)

Aim

Assess compliance with a burns specific analgesia guideline for adults to ensure equitable access to adjuvant analgesics.

Methods

Digital analgesia administration records were obtained for 280 consecutive burns admissions.

Results

Paracetamol was administered to 98% of patients (274/280), suggesting that prescription of this drug is routine. Non-steroidal anti-inflammatory drugs (NSAIDs) were administered to 74% (206/280) of all patients. Eighty-nine percent of these (183/206) received selective COX2 inhibitors, 6%(12/206) received non-selective NSAIDs and 5% (11/206) received both at some stage.

Pregabalin was administered to 53% (147/280) of all patients and 69% (77/111) of those receiving sustained-release opioids.

Opioids were administered to 91% (254/280). Of this group, 16% (40/254) received neither NSAID nor pregabalin and 9% (23/254) received 4 or more opioid preparations during their admission. Selected cases were reviewed and used to inform guideline revision.

Discussion

Pregabalin is effective for acute and chronic burns pain and we hypothesis that it is inadvertently omitted in some cases.(Gray et al., 2011) NSAIDs have historically been avoided in burns due to safety concerns. (Richardson and Mustard, 2009) There is limited evidence to support their role as antipyretics in this setting but their potential role in acute or chronic burns pain has not been explored. (Promes et al., 2011) A repeat prospective audit will be conducted following launch of the revised guideline aiming to standardise adjuvant use. These findings will inform a prospective study of COX2 inhibitors in burn injury.

Biography:
Dr Ed Raby is a microbiologist and infectious disease physician who is currently studying for a PhD focussed on infection and inflammation following acute burn injury.

Dr Kristine Owen is a consultant anaesthetist with interests in burns, trauma and advanced airway management. Her research interests include thermoregulation and cognition.

Professor Fiona Wood is one of Australia’s most innovative and respected surgeons and researchers. A highly skilled plastic and reconstructive surgeon and world leading burns specialist, she has pioneered research and technology development in burns medicine.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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