The best way to relieve pain for an individual with a large area burn is by
|C||nitrous oxide inhalation|
a. During the shock phase of burn care, medications should be given intravenously. Subcutaneous and intramuscular injections are variably absorbed depending on perfusion and should be avoided.
b. Pain control is best managed with small intravenous doses of an opiate until analgesia is adequate without inducing hypotension.
c. Total elimination of pain in burn patients is not possible, short of general anesthesia. The burn patient may experience acute pain from dressing changes, operative procedures, and rehabilitation therapy exercises.
d. Patients may also have chronic background pain associated with the wound maturation process.
e. Pain management involves both pharmacologic and nonpharmacologic modalities. The mainstays of pharmacologic pain control are analgesics, principally opioids and nonsteroidal anti-inflammatory drugs.
f. Anesthetic agents, namely ketamine and nitrous oxide, are quite useful for extremely painful procedures such as dressing changes.
g. Psychotropic drugs (e.g., anxiolytics, tranquilizers, and/or antidepressants) also can be useful in the management of burn wounds.
h. The concomitant use of benzodiazepines with opioids appears to be additive and reduces opiate requirements.