Analgesia for the dressing of burns in children: a method using neuroleptanalgesia and Entonox.

IT was Smith & Hollis at East Grinstead in 1966 who first described in the British literature the use of neuroleptanalgesia for the dressing of burns. They had considerable success with the method but, as might be expected, there was some respiratory depression in a number of cases if the opiate was given in sufficient dosage to provide full analgesia. We repeated this work in Bristol in a series of twenty-seven children aged 9 months to 6 years with very similar results. We used dehydrobenzperidol in a dose of 01-0-2 mg/kg and phenoperidine in a dose ranging from 0 05 to 0O1 mg/kg (Fig. 1) given intravenously through an indwelling needle. In assessing the initial dose of phenoperidine the child's demeanour, general fitness and the extent of the procedure to be carried out were taken into consideration. Twelve cases required an additional increment of phenoperidine of 0 025 mg/kg during the procedure (Fig. 1). Analgesia was highly satisfactory in twenty-five of the twenty-seven cases and partially satisfactory in the remaining two cases. Serial blood pressure recordings could only be made in six of the patients because of the difficulty of finding an unburnt surface to apply the sphygmomanometer cuff to the arm. In these six patients a consistent but small fall in arterial pressure was noted, but in no case was the fall in the systolic pressure greater than 15 mm of mercury. The pulse rate tended to rise in most cases, but again the change was small, being no more than 20 beats/min in any patient. The effect on respiration is shown in Fig. 2 which illustrates the percentage fall in respiratory rate from the resting values in this series of patients. 0