Pain relief in burns by Dr. Sunil Keswani, National Burns Centre, Airoli

Dr Sunil Keswani
Dr Laksmi Vas
Dr Vandana Keswani
NATIONAL BURN CENTRE,
Airoli,
Mumbai

Dr. Sunil Keswani, National Burns Centre,
www.burns-india.com,
nbcairoli@gmail.com

1

Circumferential chest burns-pain restricts full
respiratory excursions ,atelectasis and pneumonias
 Pain prevents patients from eating well-nutrition
affected.
 Pain depresses the patient-psychosomatic
problems
 Pain contributory to Post burn psychosis
 Pain-poor compliance during physiotherapy-poor
rehabilitation-poor functional outcome


Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com

2



PAIN IS A FORM OF STRESS AND PRODUCES ELEVATION IN
STRESS HORMONES AND CATECHOLAMINES.

PAIN RELIEF ADVANTAGES: LESSER CHEST INFECTIONS-better compliance in Physiotherapy
 LESS CATABOLISM AND ENDOCRINE DERANGEMENTS.
 FEWER THROMBOEMBOLIC COMPLICATIONS-Earlier mobilisation
 BETTER NUTRITION-Better appetite in absence of Pain
 BETTER PSYCOLOGICAL STATUS-No pain no depression and
positive outlook to healing and DESIRE TO LIVE.
 PAIN FREE DRESSINGS MAKE PATIENTS MORE COMFORTABLE
AND DECREASES THE MORBIDITY AND MORTALITY.
 SHORTER HOSPITAL STAY.

3

 Defined as an unpleasant sensory and

emotional experience associated with actual
or potential tissue damage or described in
terms of such damage.
 Acute pain < 6wks
 Surgery,Trauma or Acute illness


4

 GRADE 1:Nonopioids +/- adjuvants
 GRADE 2:Opioids for mild to moderate +/-

nonopiods+/- adjuvant
 GRADE 3:Opioids for moderate to severe

pain+/- nonopoids+/- adjuvant

5



PAIN KILLERS e.g ULTRACET



ANTIDEPRESSANTS e.g TRYTOMER,FLUDAC.



PHENCYCLIDINE DERIVATIVEe.g KETAMINE



OPIOIDSe.g MORPHINE, HYDROMORPHONE
FENTANYL.



ROUTES OF ADMINSTRATION- ORAL OR
INTRAVENOUS THROUGH PATIENT CONTROLLED
ANALGESIA PUMPS (SYRINGE INFUSION PUMPS)

6

 Antidepressant & Serotonin-uptake inhibitor
 Dose-20 mg daily-for depression
 Other names-Fluchem, Fludawn, Flugen
 Availability-10 mg, 20 mg, 60 mg caps


7

 Phenylpiperidine -analogue of codeine
 Mechanisim

 1) Activates opioids receptors

 2) Inhibits Neuronal uptakes of nor-

epineprhrine
 3) Potentiates release of serotonin
 4) Decending inhibition of nociception

8

 Names-Ketalar,Ketamax,Ketmin
 Profound analgesia
 Pharangeal & Laryngeal reflexes retained
 Dissociative Anaesthesia
 BP increases but returns back within 15 mins

after IV

9



Synthetic opioid

IV 75-125 times more potent than Morphine
Patch 30-40 times more potent than Morphine
Opioid profile of analgesia
Respiratory depression
 Muscle rigidity abolished by Naloxone
 CVS –hardly any effect
 Availability 50mcg/ml and 2,10ml
 Names-Fendrop,Fenlate,Trofentyl






10


11


12


13


14


15

 FIRST DAY:-ON ADMISSION, ALL MEDICINES TO BE
GIVEN ORALLY.

 Body wt < 10KG

3mg midazolam+50mgketamine mix it with
fruit concentrate and give orally.
 Body wt. 10—15kgs—upto 2 years of age.

4.5mg midaz+75 mg of ketamine,

16

 ADULTS:-body wt-25-50kg—

10-15mg Midaz+175-250mg Ketamine
 ALL PATIENTS

Fludac
10mg in the morning
Tryptomer 10mg HS
. Pregabalin 75mg HS

17

MILD PAIN / MIXED BURNS / LESS%BURNS
Tab Ultracet 1tds for men .1/2 to1-1/2 for small
women and children.
 Tab Tryptomer 10 mg HS.
 Tab Fludac 10 mg in the morning.




ASSESS PAIN


18

MOD PAIN /MIXED BURNS/HIGH % BURNS
Start Ketamine 100mg,Tramadol 100mg,&
Midazolam 10mg Infusion
 Set pump rate at 1ml/hour.For 60kg-1-2ml/hr.
 For 70kg- 1-4ml/hr.




ASSESS PAIN and TITRATE



If increasing give bolus of 1ml at a time assess,set
basal flow rate again.

19

 Starvation protocol as for anaesthesia
 6hours for solids & milk,2hours for juices &

water.
 Jonac suppository / IM Dynapar
 Start infusion of ketamine,tramadol,
midazolam.
 Dresssings soaked in 30cc 2%Xylocaine- in 500
cc saline for 15 mins and then removed
 Patient should be talking all the time.
 Patient should not become unconscious at any
time.

20

 Visual Analogue Scale
 McGill Pain Questionnaire


21


22

.

(1) What Does Your Pain Feel Like?
(2) How Does Your Pain Change with Time?
(3) How Strong is Your Pain?


23


24

 Interpretation:
 • minimum pain score: 0 (would not be seen

in a person with true pain)
 • maximum pain score: 78
 • The higher the pain score the greater the

pain.

25


26

Dr. Sunil Keswani, National Burns Centre, www.burns-india.com,
nbcairoli@gmail.com

27


28


29


30

PHYSICAL DEPENDENCE:-PHYSIOLOGIC




ADAPTATION OF THE BODY TO THE PRESENCE OF AN
OPIOID. IT DEVELOPS IN ALL PATIENTS ON OPOIDS FOR
SEVERAL WEEKS.
THIS IS NOT ADDICTION.
WITHRAWAL CAN BE AVOIDED BY TAPERING THE DOSE
OF OPIOIDS.

TOLERANCE IS THE NEED FOR A HIGHER DOSE TO


PRODUCE THE SAME PHARMACOLOGIC EFFECT.
THIS TOO IS NOT ADDICTION.


31

ADDICTION OR PSYCHOLOGICAL DEPENDENCE:CHARACTERISED BY COMPULSIVE BEHAVIOR
PATTERN INVOLVED IN ACQUIRING OPIOIDS FOR
NONMEDICAL REASONS AS OPPOSED TO PAIN
RELIEF.
INCIDENCE BEING 0.1%.
PSEUDO ADDICTION:-REPEATED REQUESTS FOR
OPIOIDS MAY MIMIC ADDICTION.
THIS IS DUE TO INADEQUATE PAIN RELIEF.

32

“The purpose of a physician is to

relieve pain and cure disease”


33

THANK YOU
NATIONAL BURNS CENTRE

BURNS HELPLINE 027793333
www.burns-india.com

34

Pain relief in burns by Dr. Sunil Keswani, National Burns Centre, Airoli

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Pain relief in burns by Dr. Sunil Keswani, National Burns Centre, Airoli

Similar to Pain relief in burns by Dr. Sunil Keswani, National Burns Centre, Airoli (20)

More from NationalBurnsCentre2000

More from NationalBurnsCentre2000 (11)

Recently uploaded

Recently uploaded (20)

Pain relief in burns by Dr. Sunil Keswani, National Burns Centre, Airoli