The Effect of Analgesia with Ketamine, Morphine and Paracetamol for burn pain in north-eastern Iran
-
Mehrdad Mokarram
,
Alireza Sedaghat
,
Nasibeh Lotfalizadeh
,
Maliheh Ziaee
,
Negar Morrovatdar
,
Soheila Bicheranloee
Abstract
Background: Pain is a common and challenging problem in burn patients. The severity of pain in these patients often requires multi drug therapy. On the other hand, with increasing the number and dosage of drugs, the complications increase, so finding an instruction that provides acceptable analgesia with minimal complications is necessary.
Methods: Based on the dose and half-life, the initial dose for paracetamol was 15 mg/kg every 6 hours, this dose was reduced to 30% after three days of initiation of the treatment to prevent liver toxicity and was discontinued after one week. Morphine started with an initial dose of 0.01 mg/kg/h and for opioid-tolerant patients, the initial dose was 0.02 mg/kg/h. Morphine infusion dose raised by 30 percent every week. The continuous intravenous infusion of ketamine (0.15 mg/kg/hr) with continuous intravenous infusion of morphine was administered by a silicone pump.
Results: The mean NRS was significantly reduced in the first visit after the intervention (three hours later) (8.5 ± 1.04 vs.3.9 ± 1.74; p <0.001) and this decrease was observed in NRS in continuous observations (P> 0.001). Pain reduction was independent of history of opioids use.
Conclusion: Continuous infusion of ketamine, morphine and paracetamol showed an effective pain management program for burn patients.
[2] Abdi S, Zhou Y. Management of pain after burn injury. Curr Opin Anaesthesiol, 2002; 15:563.
[3] Sharar SR, Carrougher GJ, Selzer K, O'Donnell F, Vavilala MS, Lee LA. A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabil. 2002; 23(1):27-31.
[4] Kariya N, Shindoh M, Nishi S, Yukioka H, Asada A. Oral clonidine for sedation and analgesia in a burn patient. J Clin Anesth. 1998; 10(6):514-7.
[5] Lyons B, Casey W, Doherty P, McHugh M, Moore KP. Pain relief with low-dose intravenous clonidine in a child with severe burns. Intensive Care Med. 1996; 22(3):249-51.
[6] Richardson P, Mustard L. The management of pain in the burns unit. Burns. 2009; 35:921.
[7] Martin-Herz SP, Patterson DR, Honari S, Gibbons J, Gibran N, Heimbach DM. Pediatric pain control practices of North American Burn Centers. J Burn Care Rehabil. 2003; 24(1):26-36.
[8] Patterson DR, Ptacek JT, Carrougher GJ, Sharar SR. Lorazepam as an adjunct to opioid analgesics in the treatment of burn pain. Pain. 1997; 72:367.
[9] Vulink N, Figee M, Denys D. Review of atypical antipsychotics in anxiety. EurNeuropsychopharmacol. 2011; 21:429-49.
[10] Richardson P, Mustard L. The management of pain in the burns unit. Burns. 2009; 35:921-36.
[11] Filkins SA, Cosgrav P, Marvin JA. Self-administered anesthesia: A method of pain control. J Burn Care Rehabil, 1981; 2:33.
[12] Yuxiang L, Lu T, Jianqiang Y, Xiuying D, Wanfang Z, Wannian Z, et al. Analgesia effect of a fixed nitrous oxide/oxygen mixture on burn dressing pain: study protocol for a randomized controlled trial, Trials. 2012; 13:67.
[13] Dimick P, Helvig E, Heimbach D, et al. Anesthesia-assisted procedures in a burn intensive care unit procedure room: benefits and complications. J Burn Care Rehabil, 1993; 14:446-9.
[14] Powers P, Cruse C, Daniels S, Stevens B. Safety and efficacy of debridement under anesthesia in patients with burns. J Burn Care Rehabil,1993; 14:176-80.
[15] Khajavi MR, Sabouri SM, ShariatMoharari R, Pourfakhr P, Najafi A, Etezadi F, et al. Multimodal Analgesia with Ketamine or Tramadol in Combination With Intravenous Paracetamol After Renal Surgery. Nephrourol Mon. 2016; 8(4).
[16] McGuinness SK, Wasiak J, Cleland H, Symons J, Hogan L, Hucker T, et al. A systematic review of ketamine as an analgesic agent in adult burn injuries. Pain Med. 2011; 12(10):1551-8.
[17] Schulte H, Sollevi A, Segerdahl M. The synergistic effect of combined treatment with systemic ketamine andmorphine on experimentally induced windup-like pain in humans. AnesthAnalg. 2004; 98(6):1574-80
[18] Gregoretti C, Decaroli D, Piacevoli Q. Analgo-Sedation of Patients with Burns Outside the Operating Room. Drugs. 2008; 68 (17): 2427-2443.
[19] Miller R, Cohen N, Miller’s Anesthesia, eight’s edition, Philadelphia; Elsevier Sanders,2015:ch 98,p 2977, table 98-1.
[20] Bameshki A, Mirhoseini M, Jahanbakhsh S, Soltani G, (Persian). Effects of oral ketamine on pain severity in burn patient. Anaesthesia and critical care 2005; 2(50).
[21] Bameshki AR, Mirhosseini ME, Jahanbash S, Soltani G. Evaluation of oral ketamine for postoperative pain in burn patients. J Anesthesiology and ICU care. 2005; 50 (2):30-35.
[22] Ostadalipour A, Jamshidi M, Zamani A, Jamshidi M, Ashrafi Tavasoli A. Analgesic and antisympathetic effects of clonidine in burn patients, a randomized, double-blind, placebo-controlled clinical trial. IJPS. 2007; 40 (1):29-33.
| Files | ||
| Issue | Vol 9 No 2 (2023): Spring |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i2.12515 | |
| Keywords | ||
| Burn Pain Ketamine Morphine Paracetamol Analgesia | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
