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Updated: Aug 21, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients
Adanech Shiferaw1, Simeneh Mola1, Amanu Gashaw2
1Dilla University, College of Medicine and Health Science, Dilla, Ethiopia.
Insights
Effective pain and anxiety management for children with burns undergoing wound care is crucial. This review recommends non-pharmacological methods combined with analgesics, and specific sedative-analgesic combinations for optimal procedural pain control.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Anxiety Disorders
Background:
- Pediatric burn patients frequently experience untreated pain, leading to anxiety disorders in up to 38% of cases.
- Effective management of procedural pain and anxiety is essential for pediatric burn victims.
- This review aimed to establish an evidence-based guideline for procedural pain management and sedation in children with burns.
Purpose of the Study:
- To develop an evidence-based guideline for procedural pain and sedation management in pediatric burn patients.
- To synthesize current evidence on effective pain and anxiety control strategies for burn wound care procedures in children.
Main Methods:
- Literature search conducted across multiple databases (Cochrane, PubMed, Google Scholar, Embase, Web of Science, Hinari).
- Keywords included 'pediatrics', 'children', 'burn', 'procedural wound care', 'non-pharmacological', 'analgesia', 'pain management', and 'sedation'.
- Studies were selected based on interventions, outcomes, population, and methodological quality, with 6 systematic reviews, 1 observational study, and 16 RCTs appraised.
Main Results:
- Non-pharmacological strategies are recommended as adjuncts to analgesics tailored to the child's needs.
- Ketamine-dexmedetomidine is identified as an effective first-line analgesic-sedation option.
- Other effective sedative-analgesic options include ketamine-propofol, propofol-remifentanil, propofol-fentanyl, and ketamine-midazolam.
Conclusions:
- A combination of non-pharmacological methods and appropriate analgesics is recommended for managing procedural pain and anxiety in pediatric burn patients.
- Specific sedative-analgesic combinations, such as ketamine-dexmedetomidine, offer effective first-line treatment.
- The guideline provides evidence-based recommendations for optimizing care during wound care procedures.
Background:
Almost all children with burns experience pain as a result of a complex pathophysiologic process that is usually untreated, and up to 38% of all pediatric burn victims develop anxiety disorders due to pain after hospital admission. Hence, it is important to manage pain and anxiety in the care of burn victim children. The goal of this review was to develop an evidence-based guideline for procedural pain management and sedation for burned children undergoing wound care procedures.
Methodology:
The review was reported according to Reporting Items for practice Guidelines in Healthcare (RIGHT) protocol. A search of literature was done from Cochrane review, PubMed, Google Scholar, Embase, web of science and Hinari database key words "pediatrics", "children", "burn", "procedural wound care", "wound dressing", "non-pharmacological", "analgesia", "pain management" and "sedation" were used. Extraction and filtering of the results was determined based on the interventions, outcome, population, and methodological quality, and inclusion and exclusion criteria. Finally, 6 systematic review and meta-analysis, 1observational study, and 16 randomized control trial Studies were appraised for quality, and conclusion was made based on their level of evidence and grade of recommendation.
Conclusion And Recommendation:
For effective management of procedural pain and accompanying anxiety during WCP in children, we recommend using non-pharmacological strategies as an adjunct with calculated dose of analgesics based on the children's analgesic requirements. We also recommend ketamine-dexmedetomidine as an effective first-line analgesic-sedation, and ketamine-propofol, propofol-remifentanil, propofol-fentanyl, and ketamine-midazolam as useful sedative-analgesic options.
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