title: Comparative evaluation of antipruritic protocols in acute burns. The emerging value of gabapentin in the treatment of burns pruritus.
abstract: Pruritus is a distressing symptom in burns rehabilitation and its treatment represents a challenge for the multidisciplinary burns team. We conducted a comparative study of two different therapeutic approaches in hospitalized burns patients using a combination of pharmacological agents. The observed symptomatic response to gabapentin as monotherapy as well as in combination therapy with two antihistamines was higher than chlorpheniramine alone and in combination with another two antihistamines (t = 3.70, df = 89, P < .001 for monotherapy and chi(2) = 12.2, df = 1, P = .001 for polytherapy). Patients with higher initial itch scores needed a combination of pharmacologic agents for effective symptomatic relief. A linear regression model showed that the likelihood of failure of monotherapy was marginally associated with decreasing patient age (P = .013) and increasing TBSA (P = .021, sum of square = 1.986, df = 2, P = .04). A combined approach using centrally and peripherally acting agents is most effective in the treatment of acute burns pruritus.
authors.affiliation: St. Andrew's Centre for Plastic Surgery and Burns, East Wing, Broomfield Hospital, Chelmsford, UK.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Goutos
authors.forename: Mohammed
authors.initials: M
authors.lastname: Eldardiri
authors.forename: Aadil A
authors.initials: AA
authors.lastname: Khan
authors.forename: Peter
authors.initials: P
authors.lastname: Dziewulski
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000008:administration & dosage*; D000700:Analgesics / Q000008:administration & dosage*; D002056:Burns / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002744:Chlorpheniramine / Q000008:administration & dosage; D002985:Clinical Protocols; D015331:Cohort Studies; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D003533:Cyproheptadine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006634:Histamine H1 Antagonists / Q000008:administration & dosage*; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage; D007223:Infant; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D006634:Histamine H1 Antagonists; D003533:Cyproheptadine; D006919:Hydroxyzine; D002744:Chlorpheniramine; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin