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
Paola Andrea Chinchilla Hermida, Jairo Ricardo Moyano Acevedo
Abstract
Introduction
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.
Methodology
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.
Results
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.
Conclusion
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.
Keywords
Resumo
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.
Palavras-chave
References
1
E.A. Bittner, E. Shank, L. Woodson, et al.
Acute and perioperative care of the burn-injured patient
Anesthesiology., 122 (2015), pp. 448-464
2
N. Brusselaers, S. Monstrey, D. Vogelaers, et al.
Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality
Crit Care., 14 (2010), p. R188
3
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse
J.K. Phillips, M.A. Ford, R.J. Bonnie (Eds.), Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies Press (US), Washington (DC) (2017)
Jul 13. PMID: 29023083
4
R.J. Alencar de Castro, P.C. Leal, R.K. Sakata
Pain management in burn patients
Braz J Anesthesiol., 63 (2013), pp. 149-153
5
S. Perry, G. Heidrich, E. Ramos
Assessment of Pain by Burn Patients
J Burn Care Res., 2 (1981), pp. 322-326
6
K.S. Romanowski, J. Carson, K. Pape, et al.
American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps
J Burn Care Res., 41 (2020), pp. 1129-1151
7
D.W. Creighton, A.H. Kumar, S.A. Grant, et al.
Perioperative Multimodal Pain Management: an Evidence-Based Update
Curr Anesthesiol Rep., 9 (2019), pp. 295-307
8
D.E. Kim, K.A. Pruskowski, C.R. Ainsworth, et al.
A review of adjunctive therapies for burn injury pain during the opioid crisis
J Burn Care Res., 40 (2019), pp. 983-995
9
A. Woo, B. Lechner, T. Fu, et al.
Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review
Ann Palliat Med., 4 (2015), pp. 176-183
10
A.R. Jadad, R.A. Moore, D. Carroll, et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials., 17 (1996), pp. 1-12
11
J. Wasiak, A. Spinks, V. Costello, et al.
Adjuvant use of intravenous lidocaine for procedural burn pain relief: a randomized double-blind, placebo-controlled, cross-over trial
Burns., 37 (2011), pp. 951-957
12
L. Wibbenmeyer, A. Eid, J. Liao, et al.
Gabapentin is ineffective as an analgesic adjunct in the immediate postburn period
J Burn Care Res., 35 (2014), pp. 136-142
13
P. Kundra, S. Velayudhan, S. Krishnamachari, et al.
Oral ketamine and dexmedetomidine in adults’ burns wound dressing--A randomized double-blind cross over study
Burns., 39 (2013), pp. 1150-1156
14
S. Prakash, T. Fatima, M. Pawar
Patient-controlled analgesia with fentanyl for burn dressing changes
Anesth Analg., 99 (2004), pp. 552-555
15
M.L. Borland, R. Bergesio, E.M. Pascoe, et al.
Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: a randomized double blind crossover study
Burns., 31 (2005), pp. 831-837
16
J.J. Lee, J.A. Marvin, D.M. Heimbach
Effectiveness of nalbuphine for relief of burn debridement pain
J Burn Care Rehabil., 10 (1989), pp. 241-246
17
A. Mendoza, F.L. Santoyo, A. Agulló, et al.
The management of pain associated with wound care in severe burn patients in Spain
Int J Burn Patient Burn Trauma., 6 (2016), pp. 1-10
18
D.L. James, M. Jowza
Principles of Burn Pain Management
Clin Plast Surg., 44 (2017), pp. 737-747
19
O. Pardesi, G. Fuzaylov
Pain Management in Pediatric Burn Patients: Review of Recent Literature and Future Directions
J Burn Care Res., 38 (2017), pp. 335-347
20
T.M. Frey, T.A. Florin, M. Caruso, et al.
Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial
JAMA Pediatr., 173 (2019), pp. 140-146
21
H. Gamst-Jensen, P.N. Vedel, V.O. Lindberg-Larsen, et al.
Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines
Burns., 40 (2014), pp. 1463-1469
22
S.K. McGuinness, J. Wasiak, H. Cleland, et al.
A systematic review of ketamine as an analgesic agent in adult burn injuries
Pain Med., 12 (2011), pp. 1551-1558
23
N. Eipe, S. Gupta, J. Penning
Intravenous lidocaine for acute pain: an evidence-based clinical update
BJA Educ., 16 (2016), pp. 292-298
24
C.J. Kneib, S.H. Sibbett, G.J. Carrougher, et al.
The Effects of Early Neuropathic Pain Control with Gabapentin on Long-Term Chronic Pain and Itch in Burn Patients
J Burn Care Res., 40 (2019), pp. 457-463
25
A. Moore, S. Derry, P. Wiffen
Gabapentin for Chronic Neuropathic Pain [Internet]
Available from:
https://www.nice.org.uk/guidance/cg173 (2018)
26
J. Wasiak, P.D. Mahar, S.K. Mcguinness, et al.
Intravenous lidocaine for the treatment of background or procedural burn pain
Cochrane Database Syst Rev. (2012), Article CD005622
27
W. Barrett, M. Buxhoeveden, S. Dhillon
Ketamine: a versatile tool for anesthesia and analgesia
Curr Opin Anesthesiol., 33 (2020), pp. 633-638
28
Y. Lauwens, F. Rafaatpoor, K. Corbeel, et al.
Immersive Virtual Reality as Analgesia during Dressing Changes of Hospitalized Children and Adolescents with Burns: A Systematic Review with Meta-Analysis
Children., 7 (2020), p. 194
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