Dressing change in smaller burn wounds, baths and physical therapy

It is mostly sufficient to administer a fast acting analgesic in due time before the scheduled intervention either as intravenous bolus of the opioid analgesic that is already in the perfusor or in non-retarded form of the retarded continuous opioid treatment.

In intervention-induced pain, treatments without medication are most effective. The susceptibility varies from patient to patient. However, this form of pain management should always be considered. In many cases the anxiety caused by the upcoming interventions is a bigger problem than the pain caused by these interventions.

tion. A topic application of lidocaine does not affect the wound healing. Toxic blood concentrations were not detected [84].

The application of local anesthetics as cream does not influence local inflammation after burn trauma. A randomized double blind placebo-con- trolled study on 12 healthy patients showed that after induced burn injury (grade I and IIa), lidocaineprilocaine cream (Emla ) applied under firm dressings immediately after the burn injury and for a period of 8 hours, did not have any effect on the development of primary or secondary hyperalgesia. Compared to the placebo group, alterations in wound healing were not detected either [85].

Postoperative pain

In the immediate postoperative phase pain must be measured more often to be able to react fast to increasing pain.

Donor sites for skin grafts can be much more painful than the burned skin areas themselves. Thus, most patients require an additional pain management for the days after skin grafting.

The postoperative pain management already starts intraoperatively. Analgesia by simple wound infiltration with a local anesthetic can be used as adjuvant measure if the wound healing of burned areas or donor sites is not inhibited.

The application of regional anesthetics can improve the intra and postoperative pain management in burn injuries [82].

Cuignet et al. examined the efficacy of an additionally administered continuous intra and postoperative fascia iliaca compartment block to the donor sites in skin grafting on 20 adult patients (mean TBSA 16%). This prospective randomized double blind study showed a significant postoperative reduction of opioid consumption and significantly reduced scores on the visual analogous scale [83].

Jellish et al. examined the topic application of local anesthetics on skin donor sites in skin grafting. It was shown that topic lidocaine (lidocaine 20% solution applied as aerosol) has an analgesic effect and that the narcotics consumption was reduced in comparison to the application of sodium chloride solu-

Mental aspects

When making decisions concerning pain management, the psychosocial situation of the patient must always be considered. The sensation of pain is closely related to the overcoming of the burn trauma in the following therapy phase.

A small group of patients suffers, in particular after having spent several weeks in hospital, from depression. Depression is often linked with mood swings and varying sensations of pain.

Other factors that can intensify the sensation of pain are anxiety, worries, lack of orientation, loss of control, loneliness and insomnia. A prospective study on 28 stationary patients (TBSA 3.5 to 64%) showed a significant temporary correlation between the quality of sleep and the intensity of pain. A night without much sleep was followed by a day with significantly stronger pain [86].

These triggering factors should be avoided from the first day of the treatment on.

Intensive care unit

Large area burns and inhalation trauma require intensive care. In the intensive care unit, several additional factors concerning pain management should be considered.