The Livingston Nexobrid pain protocol - further experience in 80 patients
K Hilder, A Warwick, L Robb, J Renee, D Widdowson, H Bahia
Special thanks to E Ewing and L Cameron

Objectives
Our unit has employed Nexobrid, a pineapple based enzyme used in the debridement of burns, for five years. It is a painful process yet there is no formal analgesia protocol in the literature. We developed a successful bedside pain protocol which is fast acting, long lasting and has a quick recovery time. It is administered by our Acute Pain Team nurses, and reduces the need for invasive techniques and specialist medical staff. We present further data on the success of this protocol.
Methods
A Fentanyl based Patient Controlled Analgesia (PCA) protocol with clinician administered boluses is used in this unit. Patients’ pain scores were documented throughout the procedure, as well as their perception of their worst pain and their overall satisfaction with the treatment. All patients undergoing enzymatic debridement outwith the ITU environment utilised this protocol.
Results
Eighty patients undergoing Nexobrid burns debridement were included in this study. The PCA ran for an average duration of 4hours and 15mins with a typical dose of 421micrograms being administered. Pain was most severe on removal of the enzyme however after bolus analgesia, the mean score at this point was 3/10. Addressing the significant psychological element of the pain response was an important role of the Pain Nurses in preparing patients for the debridement process. Patient satisfaction with the treatment was reported as “very satisfied” or “satisfied” in 95% of cases. No complications were reported.
Conclusion
Our analgesia protocol is safe, easy to administer and remains well tolerated, providing a high level of patient satisfaction and low rate of complications in the enzymatic debridement of burns. Bedside use of Nexobrid, made possible by our pain protocol, was particularly beneficial during the COVID-19 pandemic when access to operating theatres was restricted. The role of the Pain Nurse in this protocol is important.

P.045 The Livingston Nexobrid pain protocol - further experience in 80 patients

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre