Cooling as analgesia for burns
Date First Published:
July 5, 2005
Last Updated:
July 29, 2005
Report by:
Saiqa Hussain, Medical Student (Manchester Royal Infirmary)
Search checked by:
Craig Ferguson, Manchester Royal Infirmary
Three-Part Question:
In [adult burns patients] is [local cooling] an [effective analgesic]?
Clinical Scenario:
A 30 year-old woman presents to A&E after having burnt her forearm on a gas stove whilst cooking dinner. She is complaining of a moderate amount of pain. You wonder whether cooling the burn will relieve some of her pain.
Search Strategy:
Medline using the OVID interface 1966-06/05
Search Details:
[exp BURNS/ or burn$.mp. or thermal injury$.mp.] AND [cooling.mp. or cool$.mp.] AND [exp Analgesics/ or exp Pain/ or exp ANALGESIA/ or exp ANALGESICS or analgesic.mp. or analgesia.mp. or painkiller$.mp.] LIMIT to humans AND English Language
EMBASE 1980-06/05
[exp BURNS/ or burn$.mp. or thermal injury$.mp.] AND [cooling.mp. or cool$.mp.] AND [exp Analgesics/ or exp Pain/ or exp ANALGESIA/ or exp ANALGESICS or analgesic.mp. or analgesia.mp. or painkiller$.mp.] LIMIT to humans AND English Language
EMBASE 1980-06/05
[exp BURNS/ or burn$.mp. or thermal injury$.mp.] AND [cooling.mp. or cool$.mp.] AND [exp Analgesics/ or exp Pain/ or exp ANALGESIA/ or exp ANALGESICS or analgesic.mp. or analgesia.mp. or painkiller$.mp.] LIMIT to humans AND English Language
Outcome:
34 papers were found in Medline of which 1 was relevant. The Embase search produced 70 papers of which 1 was relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| First-aid treatment of burns: efficacy of water cooling. Raghupati. N. 1968 UK | 1 patient-2 partial thickness burns were produced on each forearm, one forearm was cooled, the other served as a control. 2 experiments-first, period of immersion in 17C water was 1 hour. Second, period of immersion was prolonged to two hours. | Incidence of AF | OPCAB group 40/204 (20%). CABG group 44/184 (24%). P=0.30 | Only one patient used. | |
| Pain after 1 hour immersion | Cooled forearm felt comfortable whilst in the water but felt uncomfortable and more painful than the control when taken out of the water. | ||||
| Death, MI , stroke or renal failure | OPCAB group 6/204 (2.9%). CABG group 9/184 (4.9 %). p=0.32 | ||||
| Pain after 2 hours of immersion | Less pain in cooled forearm during immersion but once it was taken out of the water burn became uncomfortable. | ||||
| Local cooling does not prevent hyperalgesia following burn injury in humans Werner. M, Lassen. B, Pedersen. J, Kehlet. H 2002 Denmark | 24 healthy volunteers, first degree burn injuries were induced on both calves. One calf was then cooled down to 8C for 30 mins, the other acted as a control | Randomised, single-blinded study. | Combined endpoint of mortality stroke and MI, at 1 year (5 studies) | OPCAB group 23/412 (5.6%). CABG group 34/410 (8.2%). P=0.15. Odds 0.66 (0.38 – 1.15) | Study did not evaluate the analgesic effect of cooling on ongoing pain following a burn. |
| Hyperalgesic response during first 2 mins of cooling | 21 subjects correctly identified cooling thermode and reported less pain in this thermode. | ||||
| Hyperalgesic response overall | Cooling does not prevent or reduce this. |
Author Commentary:
The studies above found that cooling certainly gives immediate relief from pain but the analgesic effect quickly wears off after ceasing the cooling of the wound.
Bottom Line:
Local cooling is an effective adjunct to other analgesia in the immediate management of patients with thermal burns.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Raghupati. N.. First-aid treatment of burns: efficacy of water cooling.
- Werner. M, Lassen. B, Pedersen. J, Kehlet. H. Local cooling does not prevent hyperalgesia following burn injury in humans