Burn pain is one of the most excruciating types of
pain and can be difficult to manage.
Benzodiazepines may be effective in reducing
pain by minimizing anxiety associated with dressing changes. This study aimed to evaluate the safety and efficacy of adjunctive
midazolam during dressing changes in patients with uncontrolled
pain using
opioid monotherapy or significant anxiety associated with dressing changes. A retrospective cohort analysis comparing patients who received
midazolam during dressing changes with control patients was performed. Each
midazolam patient was matched with up to two control patients who did not receive
midazolam on the basis of age, sex, TBSA burned, and grafting requirement. The primary endpoint was the oral
morphine equivalents required during admission after initiation of
midazolam. Thirty-six patients were included for evaluation (14
midazolam and 22 control patients). Baseline characteristics were similar between the two groups, although patients in the
midazolam group had higher
pain scores and oral
morphine equivalent requirements at baseline. When adjusted for baseline
pain, day postburn, age, sex, and grafting status, total oral
morphine equivalents and mean
pain scores during admission were similar between the groups. One
midazolam patient experienced
oxygen desaturation with
midazolam, but did not require
flumazenil for reversal. The use of
midazolam during
burn dressing changes in patients with poorly controlled
pain and/or anxiety was not associated with reduced requirements for oral
morphine equivalents or lower
pain scores during admission. Further research into the role of
benzodiazepines in
burn pain management is warranted.