Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review
Eficácia de analgésicos opioides e não opioides no tratamento da dor pós-procedimento de pacientes queimados: uma revisão narrativa
Burns are a common trauma that cause acute severe pain in up to 80% of patients. The objective of this narrative review is to evaluate the efficacy of opioids, non-steroidal anti-inflammatory drugs, paracetamol, gabapentinoids, ketamine, and lidocaine in the treatment of acute pain in burn victims.
The databases explored were PubMed, Embase, ClinicalTrials, and OpenGrey. The included randomized, controlled clinical trials assessed the analgesic efficacy of these drugs on hospitalized patients, had no age limit, patients were in the acute phase of the burn injury and were compared to placebo or other analgesic drugs. Studies describing deep sedation, chronic opioid use, chronic pain, and patients taken to reconstructive surgeries were excluded. The Jadad scale was used to evaluate quality.
Six randomized controlled clinical trials (397 patients) that evaluated the analgesic efficacy of fentanyl (n = 2), nalbuphine (n = 1), ketamine (n = 1), gabapentin (n = 1), and lidocaine (n = 1) to treat post-procedural pain were included. Fentanyl, nalbuphine, and ketamine were effective, while lidocaine was associated with a slight increase in reported pain and gabapentin showed no significant differences. Two studies were of high quality, one was of medium high quality, and three were of low quality. No studies on the efficacy of NSAIDs or paracetamol were found.
Evidence of efficacy is very limited. Fentanyl, nalbuphine, and ketamine seem to be effective for controlling acute pain in burn patients, whereas gabapentin and lidocaine did not show any efficacy.
Introdução: As queimaduras são traumas comuns que causam dor aguda intensa em até 80% dos pacientes. O objetivo desta revisão narrativa é avaliar a eficácia de opioides, anti-inflamatórios não esteroidais, paracetamol, gabapentinoides, cetamina e lidocaína no tratamento da dor aguda em vítimas de queimaduras. Metodologia: As bases de dados exploradas foram PubMed, Embase, ClinicalTrials e OpenGrey. Os ensaios clínicos randomizados e controlados incluídos avaliaram a eficácia analgésica desses medicamentos em pacientes hospitalizados, não tinham limite de idade, os pacientes estavam na fase aguda da queimadura e foram comparados a placebo ou outros analgésicos. Foram excluídos estudos que descrevessem sedação profunda, uso crônico de opioides, dor crônica e pacientes levados para cirurgias reconstrutivas. A escala de Jadad foi utilizada para avaliar a qualidade. Resultados: Seis ensaios clínicos controlados randomizados (397 pacientes) que avaliaram a eficácia analgésica de fentanil (n = 2), nalbufina (n = 1), cetamina (n = 1), gabapentina (n = 1) e lidocaína (n = 1) para tratar a dor pós-procedimento foram incluídos. Fentanil, nalbufina e cetamina foram eficazes, enquanto a lidocaína foi associada a um leve aumento na dor relatada e a gabapentina não mostrou diferenças significativas. Dois estudos foram de alta qualidade, um de média alta e três de baixa qualidade. Não foram encontrados estudos sobre a eficácia de AINEs ou paracetamol. Conclusão: A evidência de eficácia é muito limitada. Fentanil, nalbufina e cetamina parecem ser eficazes no controle da dor aguda em pacientes queimados, enquanto a gabapentina e a lidocaína não mostraram eficácia.
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