The aim of this study was to evaluate
pain relief for patients with
burns during rest and mobilization with
morphine according to a standard protocol for
patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no
pain and 10 = unbearable
pain), patients were asked to estimate their acceptable and worst experienced
pain by specifying a number on a scale and at what point they would like additional
analgesics. Patients were allowed free access to
morphine with a PCA pump device. Bolus doses were set according to age, (100 - age)/24 = bolus dose (mg), and 6 minutes lockout time. Degrees of
pain,
morphine requirements, doses delivered and demanded, oral intake of food, and
antiemetics given were used as endpoints. Acceptable
pain (mean [SD]) was estimated to be 3.8 (1.3) on the NRS, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean
morphine per day was 81 (15) mg, and the number of doses requested increased during the first 6 days after the
burn. The authors found no correlation between dose of
morphine required and any other variables. Background
pain can be controlled adequately with a standard PCA protocol. During mobilization, the
pain experienced was too intense, despite having the already high doses of
morphine increased. The present protocol must be refined further to provide
analgesia adequate to cover mobilization as well.