YANIK YARALANMASI OLAN HASTANEYE YATIRILAN ERİŞKİN HASTALARDA AĞRI KESİCİ KULLANMA ALIŞKANLIKLARI

Öz

Amaç: Modern yanık bakımı, yanık ağrısının etkili yönetimine bağlıdır. Opioidler tedavinin temel taşı olmaya devam etse de, yan etkileri ciddiyetini koruyor. Bu çalışmada, yoğun bakım ünitesine yatış gerektirmeyen erişkin yanık hastalarında klinik uygulamada yaygın olarak kullanılan asetaminofen ve deksketoprofen gibi opioid olmayan ağrı kesicileri araştırdık. Yöntemler: Bu çalışmaya ardışık 13 yanıklı yatan hasta dahil edildi. Altı günlük süre boyunca, hastalar gerektiği kadar ağrı kesici kullandılar. İlaç alma zamanı kaydedildi ve ağrıyı değerlendirmek için “visual analog scale” kullanıldı. Daha sonra istatistiksel analizler yapıldı. Bulgular: Yaş ve cinsiyet grupları arasında anlamlı bir fark gözlenmedi. Yanık yüzdesi arttıkça kullanılan ağrı kesici sayısı da arttı. Hastaların ağrı kesici ilaçlarını en sık saat 11:00'de (pansuman değiştirilirken), en az saat 14:00'te aldıkları saptandı. Ağrıyı azaltmada deksketoprofen ve asetominofen etkileri arasında anlamlı bir fark gözlenmedi. Sonuçlar: Yanık hastalarında ağrı kesici ihtiyacı gün boyunca değişkenlik gösterir. Asetominofen ve deksketoprofen'in gün içindeki etkinliği pansuman değişimlerine göre daha yüksekti. Uygulanan ağrı kesici miktarı ve sıklığı ile ilgili olarak toplam vücut yüzey alanı dikkate alınmalıdır.

Anahtar Kelimeler

• ağrı kesici
• asetominofen
• deksketoprofen
• erişkin hastaneye yatırılan yanık hastası
• yanık yaralanması

THE HABITS OF USING PAINKILLER IN ADULT INPATIENTS WITH BURN INJURY

Abstract

Objectives: Modern burn care is dependent on the effective management of burn pain. Although opioids remain the cornerstone of treatment, their adverse effects remain serious. In this study, we investigated non-opioid painkillers, including acetaminophen and dexketoprofen, which are commonly used in the clinical practice for adult burn inpatients who do not require admission to an intensive care unit. Methods: Thirteen consecutive inpatients with burns were included in this study. During the six-day period, the patients self-administered painkillers as needed. The time of medication intake was recorded, and a visual analog scale was used to assess pain. Thereafter, statistical analyses were performed. Results: No significant differences were observed between age and sex groups. As the percentage of burns increased, the number of painkillers used also increased. It was found that the patients took painkillers most frequently at 11 o'clock (when the wound dressing was changed) and least frequently at 14 o'clock. No significant difference was observed between the effects of dexketoprofen and paracetamol in reducing pain. Conclusions: The need for painkillers in patients with burns varies throughout the day. The effectiveness of acetominophen and dexketoprofen during the day was higher than that during dressing changes. The total body surface area should be considered with regards to the amount and frequency of painkiller administered.

Keywords

• acetominophen
• adult inpatient with burn
• burn injury
• dexketoprofen
• painkiller

Kaynakça

1. 1- Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, Blow FC. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 2011;305:1315–21.
2. 2- Schechter NL, Walco GA. The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: above all, do no harm. JAMA Pediatr 2016;170:425–6.
3. 3- Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain–United States, 2016. JAMA 2016;315:1624–45.
4. 4- Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatricdeaths from prescription and illicit opioids, 1999–2016. JAMA Netw Open 2018;1:e186558.
5. 5-James DL, Jowza M. Principles of Burn Pain Management. Clin Plast Surg. 2017; 44(4):737-47.
6. 6- Forrest JA, Clements JA, Prescott LF. Clinical pharmacokinetics of paracetamol. Clin Pharmacokinet. 1982;7:93-107.
7. 7- Barbanoj MJ, Antonijoan RM, Gich I. Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet 2001;40(4):245-62.
8. 8- Shahi N, Meier M, Phillips R, Shirek G, Goldsmith A, Recicar J, Zuk J, Bielsky A, Yaster M, Moulton S. Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm? J Burn Care Res. 2020; 41(4):814-9.

9. 9- Leazer ST, Nyland JE, Escolas SM, Aden JK, Rauschendorfer CA, Cancio LC, Chung KK. Analgesic use in contemporary burn practice: Applications to burn mass casualty incident planning. Burns. 2020; 46(1):90-6.
10. 10-Gregorian RS, Kavanagh S. Importance of side effects in opioid treatment: a trade off analysis with patients and physicians. J Pain 2010;11:1095–108.
11. 11-Marret E. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of controlled trials. Anesthesiology 2005;102:1249–60.
12. 12- American Burn Association, 2011. Advanced Burn Life Support Course Provider Manual. American Burn Association, Chicago, IL, 25-26.
13. 13- Eken C, Serinken M, Elicabuk H, Uyanik E, Erdal M. Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial. Emerg Med J. 2014;31(3):177-81.
14. 14- Serinken M, Eken C, Karcıoğlu Ö. Intravenous Dexketoprofen versus Intravenous Paracetamol for Dysmenorrhea: A Randomized Controlled Trial. Balkan Med J. 2018; 35(4):301-5.