engleski

Managament of pain in burn injured patients

Burn pain is one the most intense and prolonged types of pain in clinical practice. It has unique characteristics, with extreme individual variability and multiple components, so optimal control of burn pain presents a challenge from the first moments of a burn injury throughout the entire period of treatment. Objective: The objective of the authors was to analyse the recent literature regarding the characteristics of burn pain, as well as optimal burn pain control. Also, the authors retrospectively reviewed the records of hospitally treated adult burn patients, regarding their pain management. Methods: The 193 patients with severe burns, who were hospitally treated during the year 2003 at the University Hospital of Traumatology in Zagreb, were selected as the sample for this study. 121 patients were males, and 72 were females, aged between 14 and 96. The hospital stay ranged from 1 to 180 days. The extent of their injures ranged from small (63, 2%), large (29%) and extensive (7, 77%). The mean TBSA was 26, 63%. On the base of medical records the authors analysed the burn pain management. Results: Continuous intravenous opiate infusions during the first days of hospitalization form the cornerstones of pain control in patients with severe burns. Because background pain is relatively constant, it was mostly treated with tramadol sustained release tablets twice daily, and then followed by NSAIDs.More severe procedural pain was treated with intravenous application of tramadol (100 mg) or morfine (10 mg), and individually tailored to each patient's requirement. Postoperative pain deserved special mention because of the increased analgesic needs 1– 4 days following surgery before returning to preoperative levels. Psychotropic agents as adjuvant pharmacotherapy for pain management as well as for psychiatric comorbidity have been prescribed to all patients. Conclusion: Burn pain vary unpredictably throughout hospitalization, and has well defined components, so pharmacotherapy should be individually tailored and continuously evaluated. Tramadol has dual mechanism of action, with pharmacological features of opioids and some antidepressants, favourable adverse-effect profile and low abuse potential, and therefore is likely to have an important role in the management of burn pain. There is also increasing evidence that tramadol can be efficacious for neuropathic pain, which can occur in burn injured patients, particularly in patients with amputations or limb evulsions.. High quality burn pain management is crucial to prevent the adverse consequences of uncontrolled burn pain, such as chronic pain and PTSD. Key words: burn pain, tramadol, optimal treatment

burn pain; managament

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