Through the nose: intranasal diamorphine (IND) analgesia
Patricia Richardson, Lucy Evans and Sarah Smailes outline a protocol for using intranasal diamorphine analgesia in patients undergoing rehabilitative physiotherapy after burn injuries
Following burn injury, physiotherapy entailing active and passive exercises is integral to maximising functional recovery. The challenge is to provide adequate analgesia with minimal side-effects or need for starvation to allow physiotherapy to be completed.
Intranasal diamorphine (IND) is established as a rapid-onset, effective and well-tolerated analgesic in accident & emergency units. We evaluated the use of IND in burn patients undergoing physiotherapy.
Thirty patients aged between 5 and 80 years, admitted to our burns ICU, with burns sized between 3 and 85%, were studied during their first experience of IND for their prescribed physiotherapy session.
Using the 0–3 pain score, patients were scored before and after physiotherapy with regard to pain during physiotherapy. Physiotherapy was completed in 28 out of 30 patients, although three patients required top-up analgesia; 25 out of 30 patients and their therapist agreed that the IND alone provided an adequate analgesic effect. No correlation was found between the ability to complete the session and burn size or age. All patients denied experiencing nausea.
We believe that IND has a role to play in the provision of analgesia to patients of all ages undergoing burns rehabilitation physiotherapy.
Physiotherapy is fundamental to maximising physical function recovery of patients following burn injury. Burn areas over joints, such as hands and feet, need particular attention to prevent contracture formation – and the physiotherapist will prescribe active exercise, and perform passive stretches and mobilisation on a daily basis over a prolonged period of time. With their rich afferent nerve supply, hand and feet wounds can be especially painful. One of the challenges for the burn clinician is achieving…
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