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A comparison of analgesia requirements in children with burns: Do delayed referrals require higher procedural

S L Wall1, D L Clarke1, N L Allorto1

  • 1Pietermaritzburg Burn Service Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

Burns Open : an International Open Access Journal for Burn Injuries
|May 31, 2022
PubMed

Insights

Delayed referral of pediatric burn patients requires higher ketamine doses for pain management. Early, adequate analgesia is crucial from the time of injury to improve outcomes.

Area of Science:

  • Pediatric Burn Care
  • Pain Management
  • Anesthesiology

Background:

  • Delayed referrals may lead to increased analgesia needs in pediatric burn patients.
  • Previous studies indicated poor analgesia protocol adherence in district hospitals.
  • Inadequate background and procedural analgesia might contribute to higher requirements.

Purpose of the Study:

  • To compare ketamine analgesia requirements for dressing changes in acute versus delayed pediatric burn referrals.
  • To investigate if delayed referral ( > 21 days post-injury) correlates with higher ketamine doses.
  • To analyze ketamine use considering length of stay and total body surface area (TBSA) burns.

Main Methods:

  • Retrospective review of pediatric patients (<12 years) admitted to Pietermaritzburg Burn Service (July 2017-June 2018).
  • Analysis of total ketamine dose, patient weight, admission days, and TBSA.
  • Calculation of ketamine use per kg per day admitted per TBSA (mg/kg/days admitted/TBSA).

Main Results:

  • 197 patients were analyzed, divided into acute (<21 days) and delayed (≥21 days) referral groups.
  • Delayed referral group (30 patients) showed a statistically significant higher median ketamine dose (0.41 mg/kg/days admitted/TBSA) compared to the acute group (167 patients, 0.27 mg/kg/days admitted/TBSA) (p=0.01).
  • The difference in ketamine requirements was significant when adjusted for length of stay and TBSA.

Conclusions:

  • Pediatric burn patients with delayed referrals necessitate higher ketamine doses for effective procedural analgesia.
  • Inadequate pain management during the acute burn phase may necessitate increased analgesia later.
  • Emphasizes the critical importance of providing sufficient analgesia from the initial injury stage.
Abstract

Keywords:
AnalgesiaBurnsDelayed referralPaediatric burnsPain

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