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

doi:10.18502/aacc.v9i2.12515

Mehrdad Mokarram Department of Anesthesiology and Critical Care, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran.
Alireza Sedaghat Department of Anesthesiology, Mashhad University of Medical Science, Mashhad, Iran.
Nasibeh Lotfalizadeh Department of Anesthesiology, Mashhad University of Medical Science, Mashhad, Iran.
Maliheh Ziaee Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
Negar Morrovatdar Clinical Research Development Unit, Imam Reza Hospital, School of Medicine, Mashhad University of Medial Sciences, Mashhad, Iran.
Soheila Bicheranloee Department of Anesthesiology, Mashhad University of Medical Science, Mashhad, Iran.

DOI: https://doi.org/10.18502/aacc.v9i2.12515

Keywords: Burn; Pain; Ketamine; Morphine; Paracetamol; Analgesia

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.