University of Washington Burn Center Pain Medication Guidelines

	Critical care treatment (without oral intake)	Critical care treatment (with oral intake)	Non-critical care treatment (large open areas)	Non-critical care treatment (small open areas/predischarge)
Background pain	Continuous morphine sulfate (IV) drip or scheduled doses or PCA	Scheduled methadone or extended-release morphine or PCA	Scheduled methadone or extended-release morphine or PCA	Scheduled NSAIDs/acetaminophen, oxycodone or none
Procedural pain	General or regional anesthesia or deep sedation for severe pain Morphine sulfate (IV), fentanyl (IV), ketamine and dexmedetomidine (IV)	Oxycodone, fentanyl IV, or oral transmucosal fentanyl or ketamine	Oxycodone, fentanyl (IV), nitrous oxide (IH), or oral transmucosal fentanyl or ketamine or propofol	Oxycodone or ketamine or propofol
Breakthrough pain	Morphine sulfate (IV) or fentanyl (IV)	Oxycodone	Oxycodone	NSAIDs/acetaminophen or oxycodone
Postoperative pain	Continuous morphine sulfate (IV) drip or scheduled doses or PCA	Scheduled methadone or extended-release morphine or PCA	Scheduled methadone or extended-release morphine or PCA	Scheduled NSAIDs/acetaminophen, oxycodone or none
Chronic pain			Gabapentin or other nonopiods or antidepressants	Gabapentin or anxiolysis or NSAIDS or antidepressants
Anxiolysis medications for background and/or procedure management
Background anxiolysis	Scheduled lorazepam (IV) or continuous lorazepam (IV) drip	Scheduled lorazepam	None or scheduled lorazepam	None
Procedural anxiolysis	Lorazepam or midazolam (IV)	Lorazepam	None or lorazepam	None
Post-hospitalization pain control
Discharge or transfer pain medications	N/A	For transfer to non-critical care treatment: wean drips; establish PO pain medication early; anticipate dose tapering as needs decrease	Oxycodone for procedural pain; methadone taper or extended-release morphine; taper if applicable	Oxycodone or NSAIDs for procedural pain

Representative pain and sedation management guideline for adult (nonpediatric, nongeriatric) burn patients from the University of Washington Burn Center. General medication recommendations are provided for specific pain and anxiolysis needs encountered in various intensive care units and ward-care settings. Medication options are intentionally limited (for simplicity) and do not include specific dose recommendations (to allow for individual patient variability). Complex or refractory cases are managed through special consultation with the burn care team and/or pain specialists.

PCA: patient-controlled analgesia; IV: intravenously; NSAIDs: nonsteroidal antiinflammatory drugs; IH: inhalation.

Graphic 59472 Version 6.0

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University of Washington Burn Center Pain Medication Guidelines