Assessment of Analgesic Effect of Self-Administered Entonox During Change of Dressing in Burn atients

Background: Many burn patients experience severe procedural pain during dressing change. Hence, pain control is a priority in the management of burn patients. Inadequate pain control may interfere with the healing process, sleep quality, daily activities and quality of life. This study was designed to evaluate the effect of Entonox in pain control during change of dressing in burn patients.Methods: This quasi-experimental study was conducted on a convenient sample of female burnt patients in the outpatient clinic of Imam Reza Burn Center during October 23, 2017- January 19, 2018. Entonox was self-administered to one-half of patients during dressing change. Control group received no systemic or topical analgesia before and during dressing change. Pain score was evaluated based on a visual analogue scale from 0-10. Student t-test, chi-squared test and ANCOVA were used in SPSS 25 for data analysis. All tests were two-tailed with a significance level of <0.05.Results: One hundred thirty-seven individuals were enrolled. Mean age of participants (39.8±12.2 years in the intervention (71 individuals) and 38.9±15.7 years in the control group (66 individuals), p=0.71), and duration between burn incidence and performing dressings (5.8±5.3 days in intervention and 7.8±9.6 days in the control group, p=0.13) was not statistically different between two groups. However, burn percentage was higher in the intervention group (4.8±2.6) than the control group (3.4±2.5)(p=0.003). Both groups were mostly burnt with scald (81% of intervention, 83% of control groups, p=0.26). After controlling for burnt percentage as a confounder, pain score was not different between two groups (4.6±3.3 in the intervention group and 3.9±3.3 in control group, p=0.24). Thirty-four percent of the intervention group reported adverse effects which were mainly dizziness.Conclusion: As we did not find any improvement in pain control and remarkable side-effects of self-administered Entonox, it seems that this method is not acceptable analgesia for outpatient management of burn wound. Appropriate pain control policy during dressing change in outpatient burns is an important issue that has yet to be determined.