Procedural Dressing Change

Dressing change was the one of the biggest source of pain as perceived by physician. Intense and prolonged pain often caused by burn injuries, the pain is exaggerated by the need to remove dressings frequently to maintain healing and banish the infection. There are some modern techniques such as skin replacement therapy and early excision that already reduced the amount of dressing changes in a burn injury (1).

Choiniere et al (2) investigated the characteristics of pain suffered by burn patients and studied that the time of greatest pain is mostly experienced during procedural dressing changes. The big goal to achieve of zero pain in procedural burn management is an achievable and perfectly realistic goal. However, pain arisen by procedural

The phenomenon is called 'wind-up' pain, as investigated on a study by Pedersen and Kehlet (11) those comprises the post-burn hyperalgesia, and frequent dressing change and its mechanical stimulation will exacerbate this condition. This 'wind-up' mechanism is the explanation of patient’s increased sensitivity during the course of burn management and somehow the main reason for greater opioid requirement for dressing changes over time

However, considering the cross-infection risk, dressings changes are carried mostly out in the patient ward. Speaking of the ideal criteria for optimal analgesia for burn dressing changes we have to ensure that there are adequately staffed and safe environment in which to care for sedated patients. The control for severe acute pain due to nociception (inflammatory response) while painful dressing change is applied (i.e. dressing removal, wound cleansing) should be alleviated by titrating analgesics agents to individual requirements. One must avoid over sedation during and following the dressing change, but always ensure enough post-procedural analgesia by considerably amount of pain assessment and monitoring of vital signs. The ideal analgesia method also need to reduce prolonged fasting as little as possible while adequate nutrition and hydration are important for the healing process.

Among those criteria mentioned above the intravenous medications, such as IV opioids, are well suited to fulfill the requirements. However, IV opioids have its drawbacks in that some patients may require such high doses of analgesia that there will be increased risk of respiratory arrest and loss of consciousness. These issues can be problematic in the early dressings change of superficial burns, while patient needs more frequent dressing change. In these cases, general anesthesia is the better solution to save the patient from