516 The Livingston Nexobrid Pain Protocol - Further Experience in 80 Patients

Abstract

Abstract Introduction Our unit has employed Nexobrid in the debridement of burns. It is a painful process yet there is no formal analgesia protocol in the literature. The team in Livingston developed a successful bedside pain protocol which is fast acting, long lasting and has a quick recovery time. It is administered by the Acute Pain Team nurses and reduces the need for invasive techniques and specialist medical staff. Method A Fentanyl based Patient Controlled Analgesia (PCA) protocol with clinician administered boluses is used in this unit. Patients’ pain scores were documented throughout the procedure, as well as their perception of their worst pain and their overall satisfaction with the treatment. All patients undergoing enzymatic debridement outwith the ITU environment utilised this protocol. Results Eighty patients undergoing Nexobrid burns debridement were included in this study. The PCA ran for around 4 hours. Pain was most severe on removal of the enzyme however after bolus analgesia, the mean score at this point was 3/10. Patient satisfaction with the treatment was reported as “very satisfied” or “satisfied” in 95% of cases. No complications were reported. Conclusions Addressing the significant psychological element of the pain response was an important role of the Pain Nurses in preparing patients for the debridement process. The analgesia protocol is safe, easy to administer and remains well tolerated, providing a high level of patient satisfaction and low rate of complications in the enzymatic debridement of burns. The role of the Pain Nurse in this protocol is important.