Elsevier

Burns

Volume 36, Issue 4, June 2010, Pages 501-505
Burns

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

https://doi.org/10.1016/j.burns.2009.08.007Get rights and content

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.

Section snippets

Patients and methods

The study was conducted in the Burn Center of the Gulhane Military Medical Academy, Ankara, Turkey. Following local ethics committee approval, written informed consent was obtained from 24 patients, aged between 19 and 54 years (median: 33 years) with burns of 20–50% (median: 37%) of the total body surface area (TBSA). Only patients with flame and scald injuries were included in the study and the study group was composed of ASA physical status II and III patients. Inhalation injuries,

Results

Cardiovascular instability or respiratory depression requiring urgent intervention or oxygen supplement was not observed. There were no episodes of vomiting, laryngospasm or emergency reaction noted in either group during or after the procedure. Table 2 shows the cardiorespiratory data.

Increase in HR was observed in 52.5%, 2.5% and 13.8% of the dressing changes in groups I, II and III, respectively. The difference was found to be statistically significant (p < 0.05).

SAP increase in more than 20%

Discussion

Pain management is a critical part of treatment in acute burns. Although pain due to burn injury was well described as a major problem more than two decades ago, investigators have continued to report that burn pain remains undertreated [12], [13]. Although several treatment options have been suggested for burn pain management, it is still a challenge in a clinical setting [1], [2], [12]. As one of the main drugs, ketamine can be used both in primary and secondary hyperalgesia; it also

Conflict of interest statement

The authors have no financial and personal relationships with other people or organisations that could inappropriately influence their work.

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