Oral ketamine for wound care procedures in adult patients with burns

Abstract

Background: This prospective study was carried out to evaluate the usefulness of oral ketamine for burn wound dressing in adult patients. The aim was to achieve a state-of-conscious sedation in which the patient would be communicative and cooperative, with minimal, or no pain during burn wound care procedures. Method: Two hundred and forty wound care procedures were randomly assigned to six treatment groups of patients (groups A-F). The quantities of oral ketamine that they received were as follows: Group A, 0.5 mg/kg; B, 2 mg/kg; C, 4 mg/kg; D, 6 mg/kg; E, 8 mg/kg and F, 10 mg/kg. A five-point verbal rating scale was used to assess pain intensity: the AVPU (alert, voice, pain, unresponsive) scale for level of consciousness. The Likert scale was used for patient satisfaction. Blood pressure, pulse rate and oxygen saturation were monitored. Adverse effects were noted. Comparisons of the efficacy and safety of the different dosages of oral ketamine were made using the SPSS package. The efficacy criterion was verbal rating scale (VRS) ≤ 2, i.e no pain, mild pain or discomfort. Results: Patients in groups A and B reported higher levels of pain, and in groups C, D, E and F, there were varying degrees of efficacy. Groups E and F had the best analgesic profiles, but at the higher doses, some patients became anaesthetised. The most common adverse effects reported were hallucination (37%) and hypersalivation (29.9%), which occurred more frequently in groups E and F. The patients' assessments of pain were best in Group D, and worst in Group A. Conclusion: The minimum effective subanaesthetic dose of oral ketamine for analgesia during wound care procedures in adult patients with burns was 6 mg/kg.

Pain care for patients with epidermolysis bullosa: best care practice guidelines

“…Ketamine can be administered enterally for wound care pain, for which there are data from adult and pediatric burn populations [ 82 ],[ 83 ] but not for EB patients. The IV form of ketamine given orally has been used with variable success for other chronic pain conditions [ 84 ] as well as in cancer patients [ 85 ] and in pediatric palliative care [ 86 ].…”

“…A number of pharmacologic treatments are available Maintain optimal nutrition and mobility and treat infections as indicated D All Denyer 2010 [ 57 ] (5a) Consider topical therapies for pain C All Cepeda 2010 [ 77 ] (1a), Lander 2006 [ 76 ] (1a), LeBon 2009 [ 73 ] (1a), Twillman 1999 [ 72 ] (5a), Watterson 2004 [ 74 ](5a) Systemic pharmacologic therapy should be adapted to treat both acute and chronic forms of skin pain B All Noble 2010 [ 59 ] (1a), Moore, 2011 [ 67] (1a), Nicholson 2009 [ 65 ] (1a) Monitor potential long-term complications of chronically administered medications C Pediatric Huh 2010 [ 62 ] (4a), Camilleri 2011 [ 66 ] (5a), Chiu 1999 [ 68 ](5a), Cruciani 2008 [ 63 ] (5a), Gray 2008 [ 69 ] (5a) D. Baths and dressing changes require attention to both pain and anxiety Anxiolytics and analgesics should be used for procedural pain and fear. Care must be taken when combining such medications due to cumulative sedative effects B All Bell 2009 [ 85 ] (1a), Blonk 2010 [ 84 ] (1b), Ezike 2011 [ 82 ] (2a), Desjardins 2000 [ 47 ] (2a), Borland 2007 [ 46 ] (2b), Manjushree 2002 [ 45 ] (2b), Humphries 1997 [ 83 ] (2b), Wolfe 2010 [ 81 ] (5a), Ugur 2009 [ 86 ] (5a) Cognitive behavioral techniques should be implemented as the child becomes old enough to use them effectively. Specifically, distraction should be used for younger children B All Green 2005 [ 14 ] (5a); Gerik 2005 [ 13 ] (5a), Palermo 2005 [ 17 ] (5a) Environ...…”