Pain management practices during wound care in patients with moderate to major burn injuries, in Kenyatta National Hospital, Nairobi

Abstract

Introduction: Daily burn wound care procedures lead to trauma and excruciating pain and this is associated with longer bed occupancy and poor outcomes. Because of different components of pain and ever changing pattern overtime, it has become difficult to control and manage procedural burn pain. The objective of the study was to determine pain management practices during wound care procedures in patients with moderate to major burn injuries in Burns Unit and ward, Kenyatta National Hospital, Kenya. Methods: The study was a cross sectional study carried out at Kenyatta National Hospital. Eighty (80) patients who met inclusion criteria were recruited into the study over a three weeks period between June and July 2013.Data was collected using structured questionnaire consisting of two parts: Patient data (demographic and pain scales) and clinician management of pain. The analysis was done using Statistical Package for Social Scientists (SPSS) version 18 and presented using charts and tables. Results: Children below 18 years of age were the majority 52%, (n=41). Mean Total Burn Surface Area (TBSA) was 24.5%. There was a higher risk of sustaining burn injuries in informal settlements in Nairobi 53.2% (n=25) compared to formal and semi formal settlements 46.8% (n=22). Kerosene stove was the main source of fire at 40% (n=32). Patients reported significant increase of pain during wound care procedures with mean pain score 8.5 SD 1.4, P=0.001 in both numerical and behavioral pain scales. Patients who were only on paracetamol analgesic reported more pain during wound care procedures (mean change 5.66) compared to morphine (mean change 4.37, P=0.033). Patients who received non pharmacological pain management practices xiii in addition to pharmacological pain management reported less pain than those who did not benefit from them, P=0.004. Conclusion: The study found that majority of patients admitted in burns unit and ward were children aged between 2-10 years and a significant proportion was from urban (informal inhabitants).Clinicians pain management practices during wound care procedures involved pharmacological as well as non pharmacological pain management, however their pain dissipation was inadequate. Public health interventional strategies need to be instituted to prevent and protect children and informal inhabitants to mitigate the dangers of fire. Innovative pain management practices combining both pharmacological and non pharmacological therapies need to be implemented and / or researched on.