Use of methoxyflurane for paediatric patients in a regional burn service outpatient clinic

Abstract

Background: Procedural analgesia is essential for burn-injured patients. Ketamine is the cornerstone of many procedural analgesia protocols for children as it is safe and effective. However, it requires monitoring and the child may remain sedated for a number of hours. We sought an alternative analgesic option. Methoxyflurane is an inhalational analgesic with rapid onset of action for short term analgesia. There is little literature on the use of this drug in children in South Africa, particularly in burns patients. This paper describes our introduction of methoxyflurane into our procedural analgesia protocols for pain associated with dressing changes for paediatric burns. Methods: We performed a retrospective review of data from the burns database for a two-month period after the addition of methoxyflurane to the paediatric burn outpatient procedural analgesia protocol as the first line analgesia option. Results: Ninety-five children were reviewed in the clinic over the two-month period. Thirty patients did not require analgesia for their dressing changes. Methoxyflurane provided effective analgesia in 49/65 (75%) patients. Conclusion: This study has shown that methoxyflurane is a viable option for analgesia for burns dressing changes in a busy outpatient setting. It is an effective and safe alternative to ketamine. Further research is required into the use of methoxyflurane in other burns settings to clarify predictors of failure, ease of use and possible side effect profiles.

Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community

“…The basis of the initial questionnaire for this Delphi study was the work previously done in analgesia in paediatric burn patients conducted in the same setting. 7,13,14 These previous studies highlighted the lack of knowledge of doctors with regard to analgesia options and doses for children with burn injuries. Although there are challenges with the implementation of protocols, analgesia protocols remain invaluable to aid healthcare professionals with little experience in the management of burn-injured children.…”