Nurse Anesthesia

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https://hdl.handle.net/20.500.11888/3201

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Browsing Nurse Anesthesia by Author "Prof. WaleedSweileh"

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    Comparison of different therapeutic regimens in pain management during dressing among burn patients
    (2016) Muhammad Ata Abu Rajab; Prof. WaleedSweileh; Dr. Noor Almasri
    Background: Pain is a major problem after burns even when high doses of opioids are administered. The study focused on the effect of using twodifferent therapeutic regimens of analgesia (Morphine with oral Celecoxib, Morphine with Intravenous Paracetamol) to relive procedural pain for burns patient compared with control group (full dose of Morphine). Methods: A randomizedcontrol study at burn unit in Rafedia governmental hospital Northern West-Bank, Palestine was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. VAS (Visual analogue scale) used to assess pain post dressing. Descriptive and statisticsanalysis was conducted using Statistical Package for Social Sciences SPSS 19. Results:Ninety patients hospitalized for burn were recruited for the study from Rafedia hospital. The mean ± SD of the patient’s age was 29.69 ± 14.96 years. More than half of the studied patients were males (53/90; 58.8%). The mean total body surface area of the burn in the studied patients was (19.54% ± 10.85%). The most common burn site among the studied patients was lower limb followed by upper limb (21/90; 23.3%) and (18/90; 20 %) respectively. The majority of the studied patients had second degree burn (55/90; 61.1%). The majority of studied patients were having either a scaled burn (44/90; 48.8%) or a flamed burn (37/90; 41.1%). Finally the majority of studied patients were not having any chronic diseases while (22/90;24.4%) were having chronic diseases. Each patient was evaluated for three consecutive daily dressings using three different treatment regimens as analgesics for the dressing; the regimen number one was (0.1) mg/kg IV Morphine, regimen number two was (0.025) mg/kg IV Morphine with (200) mg orally Celecoxib and regimen number three was (0.025) mg/kg IV Morphine with (1) g IV Paracetamol.Every treatment regimen was followed by pain assessment using VAS. One Way ANOVA analysis indicated that there is a significant difference among the three treatment regimens in VAS score (F=22.36, p<0.001, df=2). Post-hoc analysis using Tukey test indicated that both treatment regimens number one and two were not significantly different from each other. However, both treatment regimens one and two were significantly lower than treatment regimen number three suggesting that treatment regimen number 3 is the least effective in reducing pain during dressing in burn patients. Finally, analysis of VAS score of the three treatment regimens among either gender, or among either degree of burn, or type of burn or presence of chronic disease yielded similar significant results. Conclusion: This is a randomize control study indicates thatMorphine alone or Morphine with Celecoxib demonstrates that using Celecoxib in a multimodal analgesic strategy for procedural pain can achieve favorable efficacy in the manage¬ment of pain. IV Acetaminophen is ineffective in reducing opioids consumption in procedural burn pain. In fact, the VAS was significantly higher in IV Acetaminophen with Morphine-treated patients than in treated patients by Morphine or Morphine with Celecoxib. Key words: Burn, Procedural pain, Visual analogue scale.