Adequacy of Acute Pain Management in Adult Patients Admitted With Thermal Burns at Kenyatta National Hospital

Abstract

Background: Worldwide incidence of adult thermal burns is 3-10%. Thermal burns cause significant tissue injury leading to acute pain which if not adequately controlled leads to delayed wound healing, prolonged hospital stay and psychological disturbances like depression and posttraumatic stress disorder. There is paucity of literature concerning burn pain assessment and adequacy of its control in our setup. This study aimed to assess the adequacy of pain control in adult patients with thermal burns admitted to KNH. Methods: A descriptive study with a sample size of 138 adult patients admitted to KNH due to thermal burns were recruited for this study. Study duration was six months from February to July 2015. The data collected was demographic data, aetiology of burns, pain scores using Visual Analogue Scale, degree of burn and mode and type of analgesics offered. Data was analysed using STATA v.11.2, frequencies, means, medians were used to describe data. Student’s ttest & chi-square were used to test for statistical significance with p-value of < 0.05 showing statistical association. Results: Median age of the study population was 28 (IQR 22-38), majority were males 65%. Sixtyfive percent sustained moderate to major burns. Etiologies were mainly flame and scald each contributing 35% respectively. Pain assessment was not done in majority at A&E and wards 98% & 95% respectively. The correlation between TBSA and intensity of pain and degree of burn and intensity of pain was not statistically significant. Pain control at KNH was found to be inadequate with only 17% having adequate background control of pain and 7% having adequate procedural pain control. There was judicious use of analgesics at A&E (96%) but this not a common practice during change of dressing (29%). Mostly the mode of offering analgesia was unimodal 77% at A&E and during dressing. The choice of analgesics was opioids in both places. Conclusion: Pain assessment is not a common practice at KNH hence its management was very arbitrary. Pain control is inadequate amongst patients with thermal burns at KNH. These findings are

contrary to the recommendation from other burn centres. Judicious use of analgesics is recommended to control procedural pain, but at KNH only 26% of the patients received analgesics during change of dressing yet the VAS scores remained at moderate pain to severe pain despite the use of procedural analgesics.