Mohammed Abu Rajab

102 Pages·2016·2.96 MB·English

i
An-NajahNational University
Faculty of Graduate Studies

Comparison of different therapeutic regimens in pain
management during dressing among burn patients

By
Muhammad Ata Abu Rajab

Supervisor
Prof. WaleedSweileh
Co-Supervisor
Dr. Noor Almasri

This Thesis is Submitted in Partial Fulfillment of the Requirements for
the Degree of Masters of Anesthesia Nursing at the Faculty of
Graduate Studies An-Najah National University, Nablus-Palestine.
2016

iii
ءادهلإا

لملأاو لؤافتلاو ربصلا عوبني ىلإ
هلوسرو للها دعب دوجولا يف نم لك ىلإ
ةيلاغلا يمأ

رخف لكب كمسا لمحأ نم ىلإ
رغصلا ذنم كدقتفأ نم ىلإ
كركذل يبلق شعتري نم ىلإ
يلاغلا يبأ

ثحبلا اذه مكيدهأ
iv
Acknowledgment
It is my pleasure to thank all patients who were participate in this
study, my supervisors (Prof. Waleed Sweileh and Dr. Noor
Almasri) and the staff members of anesthesia and burn unit in
Rafedia governmental hospital.
v
رارقلإا
:ناونعلا لمحت يتلا ةلاسرلا مدقم هاندأ عقوملا انأ

Comparison of different therapeutic regimens in pain
management during dressing among burn patients

هيلإ ةراشلإا تمت ام ءانثتساب ،صاخلا يدهج جاتن يه امنإ ةلاسرلا هذه هيلع تلمتشا ام نأب رقأ
يثحب وأ يملع بقل وأ ةجرد ةيأ لينل مدقي مل اهنم ءزج يأ وأ ،لكك ةلاسرلا هذه نأو ،درو امثيح
. ىرخأ ةيثحب وأ ةيميلعت ةسسؤم ةيأ ىدل

Declaration
The work provided in this thesis, unless otherwise referenced, is the
researcher's own work, and has not been submitted elsewhere for any other
degree or qualification.

Student's Name: : بلاطلا مسا
Signature: :عيقوتلا
Date: :خيراتلا
vi
TABLE OF CONTENTS
No Subject Page
ءادهلإا iii
Acknowledgment iv
Declaration v
List of Tables viii
List of figure ix
List of Abbreviations x
Abstract xii
Chapter 1 Introduction 1
1.1 Background 1
1.2 Definition of the Burn 5
1.3 Epidemiology of the burn 6
1.4 Procedural Pain in Burn Patients 8
1.5 Pain Mechanisms after Burn 9
1.6 Time-course of pain 10
1.7 Types of Pain in Burn Patients 11
1.8 Assessment of pain intensity 12
1.9 Medications 12
1.10 Pain Management Options 18
1.11 Problem statement 21
1.12 Objectives of the Study 22
1.13 Significance of the study 22
Chapter 2 Literature Review 26
2.1 Research Questions and Hypotheses 29
2.2 The Hypotheses for the research questions 30
Chapter 3 Methodology 31

3.1 Study Design and Site of the Study 31
3.2 Sampling Methods and Size 31
vii
3.3 Inclusion Criteria 31
3.4 Exclusion Criteria 32
3.5 Data Collation 33
3.6 Therapeutic regimens 33
3.7 Follow up of the patient 34
3.8 Measures (variables) 35
3.9 Safety measures 35
3.10 Side effectof the drugs 35
3.11 Ethical Consideration 36
Chapter 4 Results 37
4.1 General demographic characteristics of the 37
study sample
4.2 Regimens used by the study sample 37
Chapter 5 Discussion 47
5.1 Strength and limitations of the study 53
5.2 Conclusion and Recommendation 53
References 55
Appendices 76
صخلملا ب
viii
List of Tables
No. Tables Page
1.1 Sedation and Analgesia Guidelines for Acute 4
Burns
1.2 Pharmacologic Management of Burn Pain 20
1.3 Non-pharmacologic Analgesia 21
2.1 Literature Review 26
3.1 characteristics of healing phases 32
3.2 variables of the study 35
4.1 Clinical and demographic characteristics of 39
the studied patients
4.2 The mean (95% CI) of the VAS score for each 40
treatment regimen
4.3 VAS score of the three treatment regimens 43
among different variables
4.4 VAS score for different regimen based on 44
clinical and demographic data
4.5 Anova test to different effect of treatment 45
regimens on heart rate
ix
List of Figure
No Figure Page
1 The mean (95% CI) of the VAS score for each 41
treatment regimen
2 The box-plot presentation of the vas score versus the 42
three treatment regimens
3 Different effect of treatment regimens on heart rate 46
x
List of Abbreviations

Abbreviation Full Name
1st First
2ed Second
Ca Calcium
CHEOPS Children's Hospital of Eastern Ontario Pain Scale
CHF Congestive heart failure
COPD Chronic obstructive pulmonary disease
Cox Cyclooxygenase
G Gram
H0 Null hypothesis
H1 Alternative hypothesis
HTN Hypertension
HVAS Horizontal Visual analog scale
IM Intramuscular
IQ Interquartile
IRB institutional review board
IV Intravenous
Kg Kilogram
Mg Milligram
Mint Minute
Na Sodium
NE Norepinephrine
NMDA N-methyl-d-aspartate
NSAIDs Nonsteroidal anti-inflammatory drugs
PCA Patient controlled analgesia
PGE2 Prostaglandin E2
PO Per oral
PR Per rectum
R Receptor
SD Standard deviation
SPSS Statistical Package for the Social Sciences
TBSA Total body surface area
TD Transdermal
THR Total hip replacement