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138
Burns
JEREMY ACKERMAN AND ADAM J. SINGER
n Agents
n Opioids
n NSAIDSs
n Topical and IV lidocaine
n Gabapentin
n Benzodiazepines
n Evidence
Management of burn pain remains difficult and poorly investigated. For all
but the most inconsequential of burns, factors such as burn type, burn area,
burn depth, and patient demographics are of little help in predicting the pain
control requirements. Control of pain from burns in the ED setting is complicated
by a high incidence of preexisting intoxication, the need to assess for
additional injuries, and concern about the adequacy of ventilation and
oxygenation.
Though it may be challenging, pain management in the ED is important for
patient comfort acutely, and it may have important implications for the
duration of management of the burn injury. 1–3 For those managed on an
outpatient basis, providers should keep in mind that many burns cause
significant pain in the days after the initial injury, as a result of dressing
changes and nerve regeneration.
This chapter focuses primarily on thermal burns, but some brief points
about related injuries are warranted. Electrical burns are similar to thermal
burns, but special attention should be paid to pain out of proportion to the
visualized degree of injury; such unremitting pain may indicate vascular
compromise. For chemical burns, decontamination and agent-specific therapy
(e.g. calcium for hydrofluoric acid exposure) are of paramount importance.
For most (but not all) chemical burns, irrigation will reduce pain as