In 2017, approximately 460 000 emergency department visits in the United States were attributed to fire or burn injury. Burn injury is a form of major trauma caused by the application of energy through heat or through chemical, electrical, or radiation exposure. Regardless of the severity of the injury, patients with burns need ongoing pain management. In the most severe cases, patients receive mechanical ventilation and require analgesia and sedation.

Pain management in burn patients presents a major clinical challenge because of pharmacokinetic and pharmacodynamic changes, considerations for medication selection, and lack of a standardized approach. Therefore, a tailored approach to analgesia and sedation is an integral component of the intensive care unit (ICU) stay in this patient population. Background, breakthrough, and procedural pain should be addressed when caring for these patients.

Pain after burn injury is a complex, variable process that occurs through a variety of mechanisms. Burn...

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