Evaluation of the Safety and Efficacy of a Nursing-Driven Midazolam Protocol for the Management of Procedural Pain Associated With Burn Injuries

Abstract

Burn pain is one of the most excruciating types of pain and can be difficult to manage. Benzodiazepines may be effective in reducing pain by minimizing anxiety associated with dressing changes. This study aimed to evaluate the safety and efficacy of adjunctive midazolam during dressing changes in patients with uncontrolled pain using opioid monotherapy or significant anxiety associated with dressing changes. A retrospective cohort analysis comparing patients who received midazolam during dressing changes with control patients was performed. Each midazolam patient was matched with up to two control patients who did not receive midazolam on the basis of age, sex, TBSA burned, and grafting requirement. The primary endpoint was the oral morphine equivalents required during admission after initiation of midazolam. Thirty-six patients were included for evaluation (14 midazolam and 22 control patients). Baseline characteristics were similar between the two groups, although patients in the midazolam group had higher pain scores and oral morphine equivalent requirements at baseline. When adjusted for baseline pain, day postburn, age, sex, and grafting status, total oral morphine equivalents and mean pain scores during admission were similar between the groups. One midazolam patient experienced oxygen desaturation with midazolam, but did not require flumazenil for reversal. The use of midazolam during burn dressing changes in patients with poorly controlled pain and/or anxiety was not associated with reduced requirements for oral morphine equivalents or lower pain scores during admission. Further research into the role of benzodiazepines in burn pain management is warranted.

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

“…The opioid-sparing effect of dexmedetomidine has been reported by previous studies ( Jones et al, 2014 ). Contrary to dexmedetomidine, during burn dressing changes, the opioid-sparing effect of midazolam was not obvious ( Bidwell et al, 2013 ). There is a concern of over sedation caused by the combination use of dexmedetomidine and butorphanol.…”

Psychotropic drugs and risk of burn injury in individuals with mental illness: a 10-year population-based case-control study

“…When previous studies have examined burn injuries, they have mainly assessed the sedative efficacy of psychotropic drugs for treating or managing patients with burn injuries . For example, Hansen et al reported that the use of intranasal midazolam provided positive response for burn wound care among patients with burn injury; using a randomized, double‐blind study, Norambuena et al found that the combined use of oral midazolam and ketamine in children with burn injury might provide better analgesia than treatment with the combined use of midazolam, acetaminophen, and codeine for painful procedures.…”