Pain relief during dressing changes of major adult burns: Ideal analgesic combination with ketamine

• Published in: Burns Vol. 36; no. 4; pp. 501 - 505
• Main Authors: Zor, Fatih, Ozturk, Serdar, Bilgin, Ferruh, Isik, Selcuk, Cosar, Ahmet
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-06-2010; Elsevier
• Subjects: Adult; Analgesics - therapeutic use; Bandages; Biological and medical sciences; Blood Pressure - drug effects; Burn dressing change; Burns; Burns - physiopathology; Burns - therapy; Critical Care; Dexmedetomidine; Dexmedetomidine - therapeutic use; Drug Therapy, Combination; Female; Heart Rate - drug effects; Humans; Hypnotics and Sedatives - therapeutic use; Ketamine; Ketamine - therapeutic use; Male; Medical sciences; Midazolam; Midazolam - therapeutic use; Middle Aged; Pain - prevention & control; Pain management; Pain Measurement; Patient Satisfaction; Respiration - drug effects; Tramadol - therapeutic use; Traumas. Diseases due to physical agents; Young Adult; Ketamine; Midazolam; Burn dressing change; Pain management; Dexmedetomidine; Human; Skin disease; Psychotropic; Hypnotic; Burn; Dressing; Analgesic; Clinical management; Pain; General anesthetic; Adult; Sedative
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2009.08.007

Abstract Pain management during burn dressing changes is a critical part of treatment in acute burn injuries. Although several treatment options have been suggested, it is still a challenge in a clinical setting. This study is aimed at finding out an ideal analgesic, sedative and/or anxiolytic combination that would minimise the unwanted effects of ketamine. A total of 24 patients, with burns up to 20–50% of total body surface area (TBSA), were included in the study and randomly divided into three groups. In group I, 2 mg kg−1 ketamine was administered. In group II, 1 mg kg−1 tramadol was administered and 30 min later, 1 μg kg−1 dexmedetomidine and 2 mg kg−1 ketamine was administered. In group III, 1 mg kg−1 tramadol was applied and 30 min later, 0.05 mg kg−1 midazolam and 2 mg kg−1 ketamine was administered. The evaluation was performed with cardiopulmonary monitoring, sedation and visual analogue pain scores and overall patient satisfaction. Any adverse effects of ketamine were recorded. The results showed that group II had better outcomes with respect to pain management during dressing changes. As a conclusion, the use of the combination of ketamine, tramadol and dexmedetomidine was found to be a good treatment option for the prevention of the procedural pain suffered by adult patients during dressing changes.