Ashburn M A
Department of Anesthesiology, University of Utah Health Sciences Center, Salt Lake City 84132, USA.
J Burn Care Rehabil. 1995 May-Jun;16(3 Pt 2):365-71. doi: 10.1097/00004630-199505001-00006.
Burn-related pain is often severe and intermittently excruciating for months after the initial injury as the result of the multiple procedures these patients must undergo. Procedure-related pain is often undertreated, especially in children. Pain management should be integrated into the patient's overall care plan. Frequent pain assessment with valid patient self-report measures should be the basis for documenting pain treatment efficacy. Pharmacologic methods of pain management, including the use of opioids and nonopioid analgesics, are the mainstay of pain management. The patient with burns often has altered pharmacokinetics and pharmacodynamics to drugs, and these changes must be integrated into the use of these agents. In addition, individual patient response varies widely, necessitating a highly individualized pain management plan. Sedatives, such as benzodiazepines, are often very helpful adjuncts to opioids in anxious patients but should not be substituted for analgesics. Psychological techniques have proved to be very helpful adjuncts to analgesics but should also not be sued as a substitute for analgesics. General anesthesia should be considered, especially in children, when patients are to undergo extremely painful procedures. Patients need not experience severe pain after burn injury. Pain management, especially during very painful procedures, should be an integrated part of patients care and high-quality pain management to improve patient outcome.
由于这些患者必须接受多种治疗，烧伤相关疼痛在初始损伤后的数月内通常很严重，且间歇性剧痛。与治疗相关的疼痛往往未得到充分治疗，尤其是在儿童中。疼痛管理应纳入患者的整体护理计划。使用有效的患者自我报告措施进行频繁的疼痛评估应作为记录疼痛治疗效果的基础。疼痛管理的药物方法，包括使用阿片类药物和非阿片类镇痛药，是疼痛管理的主要手段。烧伤患者对药物的药代动力学和药效学往往会发生改变，这些变化必须纳入这些药物的使用中。此外，个体患者的反应差异很大，因此需要高度个体化的疼痛管理计划。镇静剂，如苯二氮䓬类药物，在焦虑患者中通常是阿片类药物非常有用的辅助药物，但不应替代镇痛药。心理技术已被证明是镇痛药非常有用的辅助手段，但也不应作为镇痛药的替代品。当患者要接受极其痛苦的治疗时，尤其是儿童，应考虑全身麻醉。烧伤后患者不必经历剧痛。疼痛管理，尤其是在非常痛苦的治疗过程中，应成为患者护理和高质量疼痛管理的一个组成部分，以改善患者预后。
