Non-Opioid Analgesic and Sedation Strategies for Procedural Pain in Burns Patients: A Scoping Review Protocol

BACKGROUND: Burns patients undergo repeated painful procedures — including dressing changes, wound debridement, and skin grafting — over weeks to months of hospital admission. Opioids remain the historical mainstay of procedural analgesia in this population, but rapid development of tolerance, opioid-induced hyperalgesia, and the broader opioid dependence crisis have driven increasing interest in non-opioid alternatives. Despite growing use of agents such as ketamine, dexmedetomidine, propofol, nitrous oxide, gabapentinoids, intravenous lidocaine, regional nerve blocks, and non-pharmacological interventions including virtual reality and hypnosis, no comprehensive synthesis of the evidence landscape exists. Stapelberg (2020, Anaesthesia and Intensive Care) explicitly identified pain management failures and the lack of mechanism-specific analgesics as a central unresolved problem in burns anaesthesia, calling for research into non-opioid alternatives. OBJECTIVE: To systematically identify, characterise, and map the extent and nature of evidence on non-opioid analgesic and sedation strategies for procedural pain management in hospitalised burns patients. METHODOLOGY: This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis (Scoping Reviews) and reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). POPULATION: Hospitalised patients of any age with burn injuries requiring procedural pain management. CONCEPT: Non-opioid pharmacological agents (ketamine, dexmedetomidine, propofol, nitrous oxide, gabapentinoids, NSAIDs, paracetamol, intravenous lidocaine, alpha-2 agonists), regional anaesthesia techniques (peripheral nerve blocks, fascial plane blocks, tumescent anaesthesia), and non-pharmacological interventions (virtual reality, hypnosis, music therapy, distraction techniques). CONTEXT: Hospital-based burns units, burns theatres, or burn intensive care settings during burns-related procedures (dressing changes, debridement, wound bed preparation, skin grafting, escharotomy). DATABASES: MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), Cochrane CENTRAL, PsycINFO (Ovid/EBSCO), Web of Science Core Collection. Grey literature: ClinicalTrials.gov, ANZCTR, WHO ICTRP, ABA guidelines, ANZBA position statements. STUDY SELECTION: Two independent reviewers will screen titles/abstracts and full-texts using Rayyan or Covidence software. Conflicts will be resolved by consensus discussion, with a third reviewer available for unresolved conflicts. OUTCOMES: Data will be extracted on: study design, population characteristics (age, TBSA, burn depth), intervention details (agent/technique, dose/parameters, timing), comparator, outcome measures (pain scores, opioid consumption, adverse events, patient satisfaction), and key findings. REPORTING: Results will be presented using a PRISMA-ScR flow diagram, narrative synthesis, and evidence map by intervention category. Gaps will be identified and recommendations for future primary research articulated.