orabase and Pain

Despite advances in treatment of burn injuries and their consequent pain, wound care is the main source of the pain associated with burn injury. This two-part article explores burn pain and its treatment from a nursing perspective. Last month, Part 1 provided an overview of burn injury and addressed the wound care-related causes of burn pain, as well as its assessment and treatment. Part 2, presented here, provides a more in-depth discussion of pain management; topical medications and the psychological aspects of burn pain are also discussed.

Topics: Acute Disease; Analgesia; Analgesics; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Causality; Drug Monitoring; Drug Therapy, Combination; Humans; Mafenide; Nurse's Role; Pain; Polyesters; Polyethylenes; Practice Guidelines as Topic; Relaxation Therapy; Silver Sulfadiazine; Skin Care; Stress Disorders, Post-Traumatic

Studies comparing contemporary silver dressings in burns are scarce.. In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel(®) Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience.. Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel(®) Ag dressing was found for average ease of use (p<0.001), average ease of application (p=0.001), patient pain (p<0.001), patient comfort with the dressing (p=0.017), silver staining (p<0.001), and cost effectiveness (p<0.001).. Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Child; Cost-Benefit Analysis; Female; Humans; Laser-Doppler Flowmetry; Male; Metal Nanoparticles; Middle Aged; Occlusive Dressings; Pain; Pain Measurement; Polyesters; Polyethylenes; Silver Compounds; Time Factors; Treatment Outcome; Wound Healing; Wound Infection; Young Adult

: The purpose of this investigation was to determine the effectiveness of silver sulfadiazine as compared with Aquacel Ag in patients with superficial partial-thickness burns.. : Twenty-four subjects who sustained superficial partial-thickness burns who were between the ages of 19 and 53 years with time of injury from 0 to 4 days were randomly assigned into a control group (silver sulfadiazine) and experimental group (Aquacel Ag; ConvaTec, Skillman, New Jersey). Wound measurements were assessed at the time of the initial examination and every 4 days afterward until the area was re-epithelialized 100%. To ensure objectivity, the burn area was measured digitally with the software program by Aspyra (Aspyra LLC; Blue Springs, Missouri) to prevent discrepancies in wound measurements.. : Significant differences between the silver sulfadiazine and Aquacel Ag group were noted in pain (silver sulfadiazine: 4.70 ± 2.22, Aquacel Ag: 2.92 ± 1.12) and the number of treatments (silver sulfadiazine: 10.27 ± 7.46, Aquacel Ag: 4.10 ± 1.38).. : Utilization of Aquacel Ag in superficial-partial thickness burns could lead to a decrease in the number of treatments required to re-epithelialize burns 100% with less pain as compared with silver sulfadiazine.

Topics: Adult; Anti-Infective Agents, Local; Bandages; Burns; Carboxymethylcellulose Sodium; Female; Humans; Male; Middle Aged; Pain; Prospective Studies; Silver; Silver Sulfadiazine; Wound Healing

Administration of lidocaine and nonsteroidal anti-inflammatory drugs (NSAIDs) as a routine procedure for relief of dental pains by and large is restricted due to some side effects. Amitriptyline (AM) has long been known to exert analgesic activity as a result of blocking the Na⁺ channels. The objective of the present investigation was to prepare suitable buccoadhesive tablets using cellulose derivatives in order to obtain new formulations containing AM to provide local analgesic action. The tablets were evaluated in terms of physical characteristics, mucoadhesion performance, drug release, and in vivo assessment of analgesic efficiency. Tablets containing higher amounts of high-viscosity hydroxypropylmethyl cellulose (HPMC-K4M) significantly demonstrated enhanced adhesive performances. On the other hand, presence of sodium carboxymethyl cellulose (NaCMC) in formulations including HPMC of lower-viscosity grade (HPMC-E5LV) provided further adhesiveness by increase in viscosity. Rate of drug release from HPMC-E5LV tablets was significantly higher than the HPMC-K4M tablets. Kinetically, patterns of AM release from the tablets fitted best to Higuchi model. Moreover, in a randomized double-blind trial, analgesic efficiency of the prepared bioadhesive tablets was revealed to be satisfactory. It is suggested that applying the topical AM mucoadhesive tablet containing the low amount of drug is a safe and promising alternative to relief the pain in the buccal region.

Topics: Adhesiveness; Administration, Buccal; Adult; Amitriptyline; Analgesia; Analgesics, Non-Narcotic; Carboxymethylcellulose Sodium; Dentistry, Operative; Double-Blind Method; Drug Compounding; Drug Delivery Systems; Female; Hardness; Humans; Hypromellose Derivatives; Methylcellulose; Middle Aged; Pain; Pain Measurement; Tablets; Young Adult

Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection.. Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery.. The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections.. A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.

Topics: Adult; Aged; Arthroscopy; Carboxymethylcellulose Sodium; Drug Carriers; Female; Humans; Hyaluronic Acid; Male; Middle Aged; Pain; Prospective Studies; Range of Motion, Articular; Recovery of Function; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint; Tissue Adhesions; Treatment Outcome; Viscosupplements

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008. Patients were divided into two groups: Aquacel Ag-treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine-treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups. Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group (10 +/- 3 versus 13.7 +/- 4 days, P < 0.02) as well as pain scores at days 1, 3 and 7 (4.1 +/- 2.1, 2.1 +/- 1.8, 0.9 +/- 1.4 versus 6.1 +/- 2.3, 5.2 +/- 2.1, 3.3 +/- 1.9, respectively, P < 0.02). Total cost of treatment was 52 +/- 29 US dollars for the Aquacel Ag-treated group versus 93 +/- 36 US dollars for the silver sulfadiazine-treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.

Topics: Adult; Ambulatory Care; Anti-Infective Agents, Local; Body Surface Area; Burns; Carboxymethylcellulose Sodium; Cost-Benefit Analysis; Female; Hospital Costs; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pain; Prospective Studies; Silver Sulfadiazine; Skin Care; Thailand; Time Factors; Travel; Treatment Outcome; Wound Healing

Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M).. Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes.. The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001).. Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.

Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bandages; Carboxymethylcellulose Sodium; Female; Femoral Neck Fractures; Hip Joint; Humans; Knee Joint; Male; Occlusive Dressings; Pain; Postoperative Care; Prospective Studies; Surgical Wound Infection; Wound Healing

In this article, we describe a randomised trial in which two established primary dressings - Comfeel (Coloplast, UK) and Granuflex improved formulation (Convatec, UK) - were compared to Cutinova foam (Beiersdorf Medical, UK) in the management of venous leg ulcers. Patients that met the study trial criteria were randomised to receive one of the three primary dressings. All ulcers were secondarily bandaged with Comprilan (Beiersdorf Medical, UK) short-stretch compression. The three dressings were compared in terms of their ability to promote ulcer healing (closure rate and healing rate) and reduce the prevalence and severity of ulcer-associated pain, over a 12-week period. The ease with which dressings could be used in a busy outpatient clinic setting was also considered. On enrollment, groups were well matched in terms of all of the patient and ulcer parameters studies. Six patients were withdrawn for reasons unrelated to study dressings or trial procedures. Following non-parametric analysis of the study data, the three dressings were found to be equally effective at promoting ulcer healing and alleviating ulcer-associated pain. Study personnel rated Cutinova Foam as easy, if not easier, to use than Comfeel or Granuflex. This study suggests that Cutinova Foam is as safe and effective as both Comfeel and Granuflex, in the treatment of venous leg ulcers.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Bandages; Carboxymethylcellulose Sodium; Colloids; Humans; Male; Middle Aged; Organic Chemicals; Pain; Pain Measurement; Severity of Illness Index; Skin Care; Statistics, Nonparametric; Treatment Outcome; Varicose Ulcer; Wound Healing

Although oral ulcers are commonly encountered in clinical dental and medical practice, current therapeutic options with respect to pain relief are limited. This study evaluated the mucosal binding characteristics and the pain relief and protection properties of Zilactin, a hydroxypropyl cellulose film former. In 12 healthy volunteers, the mean duration of mucosal adherence of Zilactin was 3.92 hours, which was significantly longer than that of a widely available topical preparation (1.38 hours, p = 0.0001). When evaluated in 20 subjects with recurrent aphthous ulcerations, Zilactin demonstrated the ability to significantly decrease ulcer pain over a 4-hour period when compared with the subjects' individual standardized level of initial discomfort, which was used as an internal control for all subsequent steps. Challenge with an irritating citrus beverage was made before and after application of the medication. A significant difference in premedication and postmedication sensitivity was shown (p = 0.0001), indicating that the film provides protection, as well as pain relief. As a result of its unique and tenacious film-forming characteristics, this agent is exceptionally effective in the treatment of oral mucosal ulcerations. Greater awareness on the part of physicians and dentists may lead to the development of additional applications.

Topics: Adhesiveness; Administration, Topical; Adult; Carboxymethylcellulose Sodium; Cellulose; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Mouth Mucosa; Pain; Recurrence; Stomatitis, Aphthous; Time Factors

Effective assessment and management of wound pain can facilitate both improvements in healing rates and overall quality of life. From a pharmacological perspective, topical application of nonsteroidal anti-inflammatory drugs in the form of film wound dressings may be a good choice. Thus, the aim of this work was to develop novel layered film wound dressings containing ibuprofen based on partially substituted fibrous sodium carboxymethylcellulose (nonwoven textile Hcel NaT). To this end, an innovative solvent casting method using a sequential coating technique has been applied. The concentration of ibuprofen which was incorporated as an acetone solution or as a suspension in a sodium carboxymethylcellulose dispersion was 0.5 mg/cm(2) and 1.0 mg/cm(2) of film. Results showed that developed films had adequate mechanical and swelling properties and an advantageous acidic surface pH for wound application. An in vitro drug release study implied that layered films retained the drug for a longer period of time and thus could minimize the frequency of changing the dressing. Films with suspended ibuprofen demonstrated higher drug content uniformity and superior in vitro drug release characteristics in comparison with ibuprofen incorporation as an acetone solution. Prepared films could be potential wound dressings for the effective treatment of wound pain in low exuding wounds.

Topics: Bandages; Carboxymethylcellulose Sodium; Humans; Ibuprofen; Pain; Wound Healing

To report three cases of bilateral microbial keratitis in eyes with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by highly active antiretroviral therapy (HAART) in patients of acquired immune deficiency syndrome (AIDS).. A case series.. A detailed clinical examination and systemic review of all the three patients on HAART was performed. While one manifested with the more severe variant of TEN, two of these patients presented with SJS with ocular involvement. Despite withdrawal of nevirapine, the ocular surface disorder persisted. The entailing chronic epitheliopathy along with the compromised immune status led to the development of secondary microbial keratitis in all these cases.. The immune reconstitution occurring as a response to the antiretroviral therapy may potentially increase immunologically mediated diseases like SJS and TEN, which in turn may predispose the eye to develop corneal ulcer.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amnion; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Aza Compounds; Benzamidines; Carboxymethylcellulose Sodium; Cefazolin; Chlorhexidine; Corneal Ulcer; Drug Therapy, Combination; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Pain; Quinolines; Stevens-Johnson Syndrome; Tobramycin; Treatment Outcome; Tropanes; Visual Acuity

Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.

Topics: Alginates; Carboxymethylcellulose Sodium; Contraindications; Cost-Benefit Analysis; Humans; Occlusive Dressings; Pain; Surgical Wound Infection; Wounds and Injuries

Topics: Analgesia; Carboxymethylcellulose Sodium; Catheters, Indwelling; Drug Combinations; Gelatin; Humans; Injections, Epidural; Methylcellulose; Morphine; Neoplasms; Pain; Pectins; Polyenes; Tissue Adhesives