Patient-controlled analgesia for background pain of major burn injury

Lin, Yun-Nan; Huang, Chien-Chung; Su, Nuan-Yen; Lee, Chia-Lin; Lao, Hsuan-Chih; Lin, Chia-Shiang; Chen, Chien-Chuan

doi:10.1016/j.jfma.2018.05.008

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Pain management is a central component of the treatment of burn patients [ 57 , 58 ]. In China, in the past decade, a growing number of burn and pain specialists have gradually realized the importance of analgesia in controlling excessive stress in severe burn patients and have prescribed zero/low opioid background intravenous PCA for them [ 59 , 60 ]. In this study, we found that opioid PCA or intermittent opioid analgesia (rather than continuous intravenous injection of opioids) at a constant rate is safer and associated with more survival benefits in severe burn patients.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

Qin

et al. 2022

Military Med Res

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Background Data on severe and extensive burns in China are limited, as is data on the prevalence of a range of related gastrointestinal (GI) disorders [such as stress ulcers, delayed defecation, opioid-related bowel immotility, and abdominal compartment syndrome (ACS)]. We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality. Methods This retrospective analysis was conducted on patients with severe [≥ 20% total burn surface area (TBSA)] and extensive (> 50% TBSA or > 25% full-thickness TBSA) burns admitted to three university teaching institutions in China between January 1, 2011 and December 31, 2020. Both 30- and 90-day mortality were assessed by collating demographic data, burn causes, admission TBSA, % full-thickness TBSA, Baux score, Abbreviated Burn Severity Index (ABSI) score, and Sequential Organ Failure Assessment (SOFA) score, shock at admission and the presence of an inhalation injury. GI dysfunction included abdominal distension, nausea/vomiting, diarrhoea/constipation, GI ulcer/haemorrhage, paralytic ileus, feeding intolerance and ACS. Surgeries, length of intensive care unit (ICU) stay, pain control [in morphine milligram equivalents (MME)] and overall length of hospital stay (LOHS) were recorded. Results We analyzed 328 patients [75.6% male, mean age: (41.6 ± 13.6) years] with a median TBSA of 62.0% (41.0–80.0%); 256 (78.0%) patients presented with extensive burns. The 90-day mortality was 23.2% (76/328), with 64 (84.2%) of these deaths occurring within 30 d and 25 (32.9%) occurring within 7 d. GI dysfunction was experienced by 45.4% of patients and had a significant effect on 90-day mortality [odds ratio (OR) = 14.070, 95% confidence interval (CI) 5.886–38.290, P < 0.001]. Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and % full-thickness TBSA. Overall, 88.2% (67/76) of deceased patients had GI dysfunction [hazard ratio (HR) for death of GI dysfunction = 5.951], with a survival advantage for functional disorders (diarrhoea, constipation, or nausea/vomiting) over GI ulcer/haemorrhage (P < 0.001). Conclusion Patients with severe burns have an unfavourable prognosis, as nearly one-fifth died within 90 d. Half of our patients had comorbidities related to GI dysfunction, among which GI ulcers and haemorrhages were independently correlated with 90-day mortality. More attention should be given to severe burn patients with GI dysfunction.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

Qin

et al. 2022

Military Med Res

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“…The amount of pain medication needed varies based on the severity of the injury. A retrospective analysis of intravenous patient-controlled analgesia (IV-PCA) use in burn patients following a mass casualty explosion in Taiwan found that TBSA and higher pain scores were associated with higher use of IV-PCA morphine (Lin et al, 2019).…”

Section: Pain Managementmentioning

confidence: 99%

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

Engel¹,

McBain²,

McBirney³

et al. 2020

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RRA807-1

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“…228 An effective morphine regimen involves no loading dose, patient-demand doses of 1.5 mg with a lockout time of 7 min, and a 24-h maximum dose of 180 mg, with up to three additional 3 mg boluses every 4 h as required and other adjuncts such as midazolam and ketamine when required. 229 For brief breakthrough analgesia during procedures, inhaled methoxyflurane is effective 230 and it provides superior analgesia compared with a midazolam and ketamine PCA during dressing changes. 230 Lidocaine infusion has been used for breakthrough pain but there is minimal evidence to support its use.…”

Section: Perioperative Managementmentioning

confidence: 99%

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

Lang

Zhao²,

Kim

et al. 2019

Advances in Wound Care

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Burns are debilitating, life threatening, and difficult to assess and manage. Recent advances in assessment and management have occurred since a comprehensive review of the care of patients with severe burns was last published, which may influence research and clinical practice. Recent Advances: Recent advances have occurred in the understanding of burn pathophysiology, which has led to the identification of potential biomarkers of burn severity, such as protein C. There is new evidence about the potential superiority of natural colloids over crystalloids during fluid resuscitation, and new evidence about components of initial and perioperative management, including an improved understanding of pain following burns. Critical Issues: The limitations of the clinical examination highlight the need for imaging and biomarkers to assist in estimations of burn severity. Fluid resuscitation reduces mortality, although there is conjecture over the ideal method. The subsequent perioperative period is associated with significant morbidity and the evidence for preventing and treating pain, infection, and fluid overload while maximizing wound healing potential is described. Future Directions: Promising developments are ongoing in imaging technology, histopathology, biomarkers, and wound healing adjuncts such as hyperbaric oxygen therapy, topical negative pressure therapy, stem cell treatments, and skin substitutes. The greatest benefit from further research on management of patients with burns would most likely be derived from the elucidation of optimal fluid resuscitation protocols, pain management protocols, and surgical techniques from randomized controlled trials.

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Patient-controlled analgesia for background pain of major burn injury

Abstract: 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.

Cited by 6 publications

References 17 publications

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

The Effect of Blast-Related Burn Injuries from Prolonged Field Care to Rehabilitation and Resilience: A Review of the Scientific Literature

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

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