Oral Administration of Injectable Ketamine During Burn Wound Dressing Changes

Abstract

Providing adequate analgesia during burn wound care is essential to patient-centered care. Both oral and intravenous (IV) ketamine are often used for analgesia and sedation. Ketamine may improve analgesia and decrease opioid requirements for burn wound care. Oral ketamine wafers and tablets have been used as a safe alternative internationally but are unavailable in the United States. The purpose of this study was to compare opioid usage and patient satisfaction scores in patients with and without the use of oral injectable ketamine for burn wound care, with each patient serving as their own control. Ketamine, opioid, and benzodiazepine dosages recorded during dressing changes were compared to dressing changes without ketamine use that occurred before and after ketamine-associated sessions in each patient. Fourteen patients received oral ketamine at a median (interquartile range [IQR]) dose of 2.5 (2.2-2.7) mg/kg. Ketamine use significantly decreased opioid requirements when compared to wound care sessions that did not use ketamine both before (50 [IQR: 30-75] mg vs 75 [IQR: 46–91] mg median IV morphine equivalents, P = .0097) and after (50 [IQR: 30-75] mg vs 63 [IQR: 50-96] mg median IV morphine equivalents, P = .0042) the ketamine-associated sessions. One patient experienced hallucinations, and no adverse events were observed. Hence, oral administration of injectable ketamine was associated with a decrease in opioid requirements during dressing changes. Additionally, ketamine use improved patient satisfaction ( P = .0034). Preliminary data suggest this promising analgesia method is safe and effective for burn wound care.

The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study

“…Ketamine can be taken orally, rectally, or intranasally in addition to intravenously. There have been some investigations into ketamine taken orally [24,25]. Kundra et al investigated the effects of oral ketamine (5 mg/kg) and dexmedetomidine (4 g/kg) on pain management during burn wound dressing [24].…”

The Use of Oral Ketamine for Wound Dressing in an Adult Patient

“…The use of ketamine as an analgesic agent in sub anaesthetic doses is not a new discovery [10]. The drug has often been used off-label for wound dressing for burn victims [11,12] Ketamine is commonly licensed as anaesthetic induction agent which may have reduced its popularity as an analgesic. Nevertheless, ketamine is the only anaesthetic induction agent with analgesic properties.…”

Approach to burn treatment in the rural emergency department

“…27,28 Ketamine is a safe and reliable analgesic option 29 and it has a distinct advantage over opioids since it preserves airway and spontaneous respiratory function, causes less respiratory depression, and maintains cardiovascular stability; it is the anesthetic of choice in rural EDs. [30][31][32] Before wounds are dressed, take photographs of burn areas to provide useful information for consultation. Burns heal best in moist environments and dressings should be selected based on minimizing frequency of change.…”