Analgesia
Established doctrine states that full thickness burns are not painful. However, most full thickness injuries are associated with areas of partial thickness burn and as such, analgesia should always be considered. Equally, escharotomy is painful as it requires extension of the incision into normal skin.
Theoretically, pain could increase the size of burn by stimulation of sympathetic nervous system vasoconstriction.
The recommended analgesic is morphine:
- administer intravenously
- give small doses - 0.1 mg/kg
- reassess pain every 5-10 minutes and repeat dose until pain is controlled
- for alert patients able to comply, a patient controlled analgesic regimen is recommended if burns are extensive
Entonox can be used as a temporizing measure. Children may be treated with intranasal diamorphine.
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