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

Zor, Fatih; Öztürk, Serdar; Bilgin, Ferruh; Işık, Selçuk; Çoşar, Ahmet

doi:10.1016/j.burns.2009.08.007

Cited by 74 publications

(43 citation statements)

References 22 publications

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“…Similar benefits (analgesia enhancement) might be expected by the coadministration of tramadol and ketamine. Clinical studies have reported analgesia improvement by the concomitant administration of opioids and NMDA receptor antagonists in patients with postoperative pain [16] and with pain during dressing changes of major burns [17]. The fact that no analgesia enhancement was observed after tramadol and ketamine administration in our study might be attributed to a too small dose of ketamine used [18].…”

Section: Discussioncontrasting

confidence: 54%

Analgesic Effects of Tramadol in Combination with Adjuvant Drugs: An Experimental Study in Rats

et al. 2013

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Background: Tramadol is often coadministered subcutaneously with adjuvants to treat pain, nausea/vomiting, dyspnea and delirium in cancer patients. The aim of the study was to investigate analgesia of tramadol coadministered with adjuvants in rats. Materials and Methods: Male rats (Wistar race) received a single tramadol dose separately (0.45 mg/kg) or tramadol with haloperidol (0.45 mg/kg), midazolam (0.3 mg/kg), levomepromazine (0.35 mg/kg), metoclopramide (1.0 mg/kg), hyoscine butylbromide (1.7 mg/kg) or ketamine (0.3 mg/kg) as a single subcutaneous injection. Analgesia was measured by a tail flick test after 15, 30, 60 and 90 min of drug administration. Results: Tramadol analgesia was enhanced with haloperidol (30, 60 and 90 min) and with midazolam (60 and 90 min). Tramadol with levomepromazine (30, 60 and 90 min) and tramadol with metoclopramide (30 and 90 min) attenuated tramadol analgesia. Tramadol with hyoscine butylbromide and tramadol with ketamine did not change tramadol analgesia. Conclusions: Significant changes in tramadol analgesia after the administration of different adjuvants could be demonstrated in this experimental single-dose study. Future clinical trials have to further explore the benefits of these drug combinations.

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Section: Discussioncontrasting

confidence: 54%

Analgesic Effects of Tramadol in Combination with Adjuvant Drugs: An Experimental Study in Rats

et al. 2013

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“…Burn pain is very likely the most difficult form of acute pain to treat [41]. Management of burn pain is still a challenge in clinical settings, although several treatment options have been suggested [61]. It is necessary to combine antinociceptive treatment with antineuropathic treatment for the management of burn pain [45].…”

Section: Introductionmentioning

confidence: 99%

Puerarin alleviates burn-related procedural pain mediated by P2X3 receptors

Zhang

Gao

et al. 2011

Purinergic Signalling

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Pain is a major problem after burns. Procedural pain evoked by burn dressing changes is common in patients, and its management is a critical part of treatment in acute burn injuries. Burn pain is very likely the most difficult form of acute pain to treat. ATP contributes to inflammation, and ATP is implicated in peripheral pain signaling via actions upon P2X 3 receptors. Puerarin is extracted from a traditional Chinese medicine and may act on P2X 3 receptor mechanisms. The Visual Analogue Scale (VAS) has been shown to be a sensitive indicator of pain intensity and treatment effects. Peripheral blood mononuclear cells (PBMCs) are involved in nociception or pain after burn injury. Burn patients were randomly divided into normal saline (NS) group (salt solution is saline) and puerarin-treated group and pain (Visual Analogue Scale scores) and inflammation (PBMCs) measured. Burn pain produces a stress response, so blood glucose, insulin, and cortisol levels in burn patients were determined. Furthermore, the expression of P2X 3 protein and mRNA in PBMCs was detected. The VAS scores in the puerarintreated group were lower than those in NS group. The blood glucose, insulin, and cortisol levels in the puerarintreated group at post-dressing changes were significantly decreased in comparison with those in NS group. The expression levels of P2X 3 protein and mRNA in PBMCs of burn patients in NS group were significantly increased in comparison with those in the puerarin-treated group. Puerarin can antagonize inflammatory factors (such as ATP) and decrease the upregulated expressions of P2X 3 protein and mRNA in PBMCs after burns to decrease VAS. Thus, puerarin had an analgesic effect on procedural pain in dressing changes of burn patients related to P2X 3 receptors.

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“…Although pain has been well recognized as an important component of the management of burns, it remains undertreated. [1][2][3][4] In fact, the literature suggests that burn pain is one of the most difficult to manage. 2,[4][5][6] Pain control is very important as inadequate pain control has short-and long-term consequences for the patients.…”

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confidence: 98%

Pain and the Thermally Injured Patient—A Review of Current Therapies

Retrouvey

Shahrokhi

2015

Journal of Burn Care & Research

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Thermally injured patients experience tremendous pain from the moment of injury to months or years after their discharge from the hospital. Pain is therefore a critical component of proper management of burns. Although the importance of pain is well recognized, it is often undertreated. Acute uncontrolled pain has been shown to increase the incidence of mental health disorders and increase the incidence of suicide after discharge. Long-term poor pain control leads to an increase in the incidence of persistent pain. Most burn centers have used opioids as the mainstay analgesic, but recently, the significant side effects of opioids have led to the implementation of new and combined therapeutics. Pharmacological agents such as gabapentin, clonidine, dexmedetomidine, and ketamine have all been suggested as adjuncts to opioids in the treatment of burn pain. Nonpharmacological therapies such as hypnosis, virtual reality devices, and behavioral therapy are also essential adjuncts to current medications. This review aims at identifying the currently available pharmacological and nonpharmacological options for optimal pain management in the adult burn population.

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

Cited by 74 publications

References 22 publications

Analgesic Effects of Tramadol in Combination with Adjuvant Drugs: An Experimental Study in Rats

Analgesic Effects of Tramadol in Combination with Adjuvant Drugs: An Experimental Study in Rats

Puerarin alleviates burn-related procedural pain mediated by P2X3 receptors

Pain and the Thermally Injured Patient—A Review of Current Therapies

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