The efficacy and safety of Analgesia and sedation assisted dressing change (ASAD) in non-ICU wards: a randomized controlled trial

Burn and traumatic patients often suffer from pain, especially when dressing changes. Analgesia for ICU intubated or tracheotomised patients is generally well managed, whereas analgesia and sedation assisted dressing change (ASAD) on general wards or in outpatient clinics still needs to be further improved. The aim of this study was to compare parecoxib sodium combined with dexmedetomidine and fentanyl for sedation and analgesia in wound dressing changes in general wards. This single-center clinical trial enrolled a total of 37 patients aged between 15 and 73 years. Prior to dressing change, patients were allocated to either the parecoxib, fentanyl, and dexmedetomidine group (PFD group) or the fentanyl and dexmedetomidine group (FD group). PFD group received intravenous parecoxib (40 mg) one hour before the procedure, dexmedetomidine as a loading dose (1 μg/kg infused over 10 minutes) followed by a maintenance infusion (0.5 μg/kg/h) if the procedure lasted beyond 10 minutes, and fentanyl (0.05 mg) injected one minute before the dressing change, with an additional 0.05 mg allowed if the Visual Analog Scale score exceeded 5; FD group received the same dexmedetomidine and fentanyl without parecoxib. Adverse events were monitored throughout the procedure and for 24 hours post-procedure via bedside observation and telephone follow-up. Primary outcomes included hemodynamic parameters such as heart rate, blood pressure, peripheral oxygen saturation (SpO₂), and respiratory rate, as well as pain assessment scale scores. Secondary outcomes consisted of the incidence of adverse events and total drug dosage used. This trial comparing PFD versus FD analgesia during non-ICU wound dressing demonstrated: 1) Both groups achieved effective pain control (VAS <4), with PFD showing superior prolonged analgesia (lower VAS at 2 h post-dressing, p<0.05) despite transient intraprocedural VAS elevation; 2) PFD exhibited higher heart rate and DBP at 10 min/2 h post-dressing (p<0.01) alongside a trend toward elevated body temperature; 3) RASS scores indicated improved arousal in PFD at 10 min post-dressing (p<0.05); 4) Comparable opioid consumption and adverse event rates, with no severe complications. ASAD in non-ICU wards demonstrated good efficacy and safety. The combination of parecoxib sodium, fentanyl, and dexmedetomidine extended effective analgesia during ASAD.