Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000100013
Brazilian Journal of Anesthesiology
Review Article

Tratamento da dor em queimados

Pain management in burn patients

Rodrigo José Alencar de Castro; Plínio Cunha Leal; Rioko Kimiko Sakata

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Resumo

JUSTIFICATIVA E OBJETIVOS: Apesar dos avanços, ainda é observado manejo analgésico inadequado dos pacientes com queimaduras. O objetivo desta revisão foi coletar dados sobre tratamento da dor em queimados. CONTEÚDO: Foi feita revisão sobre os mecanismos de dor, avaliação do paciente com queimadura e o tratamento farmacológico e não farmacológico. CONCLUSÕES: O manejo da dor em pacientes vítimas de queimaduras ainda é um desafio por parte da equipe multiprofissional. A avaliação frequente e contínua da resposta apresentada pelo paciente é muito importante, tendo em vista os vários momentos por que passa o paciente internado em decorrência de uma queimadura, além de uma terapêutica combinada com medicações analgésicas e medidas não farmacológicas. Entender a complexidade de alterações fisiopatológicas, psicológicas e bioquímicas apresentadas por um paciente em tratamento de queimadura é o primeiro passo para alcançar o sucesso no seu manejo analgésico.

Palavras-chave

ANALGESIA, ANALGÉSICOS, CIRURGIA, Queimados, DOR, Aguda, Crônica

Abstract

BACKGROUND AND OBJECTIVES: Despite advances, inappropriate analgesic treatment for burn patients is still seen. The objective of this review was to collect data on pain management in burn patients. CONTENT: We reviewed the mechanisms of pain, burn patient assessment, as well as pharmacological and non-pharmacological treatment. CONCLUSION: Pain management in burn patients is still a challenge for the multidisciplinary team. Frequent and continuous evaluation of the patient's response is very important due to the various stages that the hospitalized burn patient goes through, as well as a combination therapy with analgesic and non-pharmacological measures. Understanding the complexity of the pathophysiological, psychological, and biochemical changes a burn patient presents is the first step to achieve success in analgesic management.

Keywords

Acute Pain, Analgesia, Burns, Chronic Pain

References

McCaffrey M, Pasero C. Pain management: problems and progress. Pain: clinical manual. 1999:712-713.

Patterson D, Sharar S. Burn pain. Bonica's management of pain. 2001:780-787.

Schafheutle EI, Cantrill JA, Noyce PR. Why is pain management suboptimal on surgical wards?. J Adv Nurs. 2001;33(6):728-737.

Twycross A. Educating nurses about pain management: the way forward. J Clin Nurs. 2002;11(6):705-714.

Weissman DE, Haddox JD. Opioid pseudo-addiction, an iatrogenic syndrome. Pain. 1989;36:363-366.

Brenner GJ, Ji RR, Shaffer S, Woolf CJ. Peripheral noxious stimulation induces phosphorylation of the NMDA receptor NR1 subunit at the PKC-dependent site, serine-896, in spinal cord dorsal horn neurons. Eur J Neurosci. 2004;20:375-384.

Dworkin RH. An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. Clin J Pain. 2002;18:343-349.

Ikeda H, Stark J, Fischer H. Synaptic amplifier of inflammatory pain in the spinal dorsal horn. Science. 2006;312:1659-1662.

Kawasaki Y, Kohno T, Zhuang ZY. Ionotropic and metabotropic receptors, protein kinase A, protein kinase C, and Src contribute to C-fiber-induced ERK activation and camp response element-binding protein phosphorylation in dorsal horn neurons, leading to central sensitization. J Neurosci. 2004;24:8310-8321.

Olgart L. Breakthrough in pain research: Charting of the synaptic network may lead to new analgesics. Nord Med. 1998;113:6-12.

Woolf CJ, Manion RJ. Pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353:1959-1964.

Courtemanche DJ, Robinow O. Recognition and treatment of the post-traumatic stress disorder in the burn victim. Burn CareRehabil. 1989;10:247-250.

Sousa FAEF. Dor: o quinto sinal vital. Rev. Latino-Am. Enfermagem. 2002;10:446-447.

Richardson P, Mustard L. The management of pain in the burns unit. Burns. 2009;35(7):921-936.

Dauber A, Osgood PF, Breslau AJ. Chronic persistent pain after severe burns: a survey of 358 burn survivors. Pain Med. 2002;3:6-17.

Mahar PD, Wasiak J, O'Loughlin CJ. Frequency and use of pain assessment tools implemented in randomized controlled trials in the adult burns population: a systematic review. Burn. 2012;38:147-154.

Abbey J, Piller N, De Bellis A. The Abbey Pain Scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliative Nurs. 2004;10(1):6-13.

Merkel SI, Voepel-Lewis T, Shayevitz JR. The FLACC: a behavioral scale for scoring post-operative pain in young children. Paediatr Nurs. 1997;23(3):293-297.

Latarjet J, Choinère M. Pain in burn patients. Burns. 1995;21:344-48.

Atchison NE, Osgood PF, Carr DB. Pain during burn dressing changes in children: relationship to burn area, depth, and analgesis regimen. Pain. 1991;47:41-47.

Perry S, Heidrich G, Ramos E. Assessment of pain in burned patients. Burn Cure Rehabil. 1981;2:322-326.

Latarjet J. La douleur de l'enfant brûlé: Bilan des pratiques. . .

Textbook of pain. 1988:402-408.

Girtler R, Gustorff B. Pain management in burn injuries. Anaesthesist. 2011;60(3):243-250.

Wiechman SA, Sharar SR, Patterson DR. Burn pain. Pain management. 2011:228-242.

Duhmke RM, Cornblath DD, Hollingshead JR. Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2004.

Gatti A, Sabato AF, Occhioni R. Control led-release oxycodone and pregabalin in the treat ment of neuropathic pain: results of a multicenter Italian study. Eur Neurol. 2009;61(3):129-137.

Malenfant A, Forget R, Papillon J. Pre valence and characteristics of chronic sensory pro blems in burn patients. Pain. 1996;67(2-3):493-500.

Marret E, Kurdi O, Zufferey P. Effects of nonsteroidal antiinflammatory drugs on patientcontrolled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005;102:1249-1260.

Giessler GA, Mayer T, Trupkovic T. Das Ver brennungstrauma. Anaesthesist. 2009;58:474-448.

Amer M, Bead VR, Bathon J. Use of nonsteroidal antiinflammatory drugs in patients with cardiovascular disease: a cautionary tale. Cardiol Rev. 2010;18(4):204-212.

Simonnet G. Preemptive antihyperalgesia to improve preemptive analgesia. Anesthesiology. 2008;108:352-354.

Cuignet O, Pirson J, Soudon O. Effects of gabapentin on morphine consumption and pain in severely burned patients. Burns. 2007;33(1):81-86.

Gray P, Kirby J, Smith MT. Pregabalin in severe burn injury pain: a double-blind, randomised placebo-controlled trial. Pain. 2011;152(6):1279-1288.

Pal SK, Cortiella J, Herndon D. Adjunctive methods of pain control in burns. Burns. 1997;23(5):404-412.

MacPherson RD, Woods D, Penfold J. Keta mine and midazolam delivered by patient-con trolled analgesia in relieving pain associated with burns dressings. Clin J Pain. 2008;24(7):568-571.

Lilburn J, Dundee J, Nair S. Ketamine sequalae evaluation of the ability of various premedicants to attenuate its psychic actions. Anaesthesia. 1978;33:307-311.

Tosun Z, Esmaoglu A, Coruh A. Propofol-ketamine vs propofolfentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes. Pediatr Anesth. 2008;18:43-47.

Visser E, Schug S. The role of ketamine in pain management. Biomed Pharmacother. 2006;60:341-348.

Perry S, Heidrich G. Management of pain during debribement: a survey of U.S. burn units. Pain. 1982;13.

Martin-Herz SP, Patterson DR, Honari S. Pediatric pain control practices of North American Burn Centers. J Burn Care Rehabil. 2003;24.

Edwards RR, Smith MT, Klick B. Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury. Ann Behav Med. 2007;34(3):313-322.

Patterson DR, Ptacek JT, Carrougher GJ. Lorazepam as an adjunct to opioid analgesics in the treatment of burn pain. Pain. 1997;72.

Martyn JAJ, Greenblatt DS, Quinby WC. Diazepam pharmacokinetics following burns. Anesth Analg. 1983;62:293-297.

Kalso E, Tramer MR, Moore RA. Systemic local anaesthetic type drugs in chronic pain: a qualitative systematic review. Eur J Pain. 1998;2:3-14.

Wasiak J, Spinks A, Costello V. Adjuvant use of intravenous lidocaine for procedural burn pain relief: a randomized double-blind, placebo-controlled, cross-over trial. Burns. 2011;37(6):951-957.

Ambrose C, Sale S, Howells R. Intravenous clonidine infusion in critically ill children: dose dependent sedative effects and cardiovascular stability. BJA. 2000;84:794-796.

Lyons B, Casey W, Doherty P. Pain relief with low-dose intravenous clonidine in a child with severe burns. Intens Care Med. 1996;22:249-251.

Gündüz M, Sakalli S, Güneş Y. Comparison of effects of ketamine, ketamine-dexmedetomidine, and ketaminemidazolam on dressing changes of burn patients. J Anaesthesiol Clin Pharmacol. 2011;27(2):220-224.

Turk DC, Salavoy P. Managing chronic illness. Cognitive behavioural treatment of illness behaviour. 1996:245-285.

Fernandez E, Turk DC. The utility of cognitive coping strategies for altering pain perception: a meta-analysis. Pain. 1989;38:123-135.

Eccleston C, Yorke L, Morley S. Psychological therapies for the management of chronic and recurrent pain in children. Cochrane Database Syst Rev. 2009.

Patterson DR. Clinical hypnosis for pain control. 2010.

Crawford HJ, Knebel T, Vendemia JMC. The nature of hypnotic analgesia: neurophysiological foundation and evidence. Contemp Hypn. 1998;15(1):22-33.

Hoffman HG, Patterson DR, Carrougher GJ. Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain. 2001;17.

Hoffman HG, Patterson DR, Carrougher GJ. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain. 2000;16.

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