In the distinctive field of pediatric burn care, clinicians daily face the challenge of managing pain and anxiety in their youngest patients. A recent study published in “Burns,” the journal of the International Society for Burn Injuries, lends insight into optimizing pain relief for children undergoing burn wound dressing changes. This groundbreaking research, led by Benjamin Grossmann from the Department of Clinical and Experimental Medicine at Linköping University and colleagues, evaluates the effectiveness of rectally administered racemic ketamine in combination with midazolam.
The Search for an Optimal Analgesic Regimen in Pediatric Burns
Each year, burns subject children to extremely painful and traumatic experiences. Achieving adequate pain control during dressing changes without causing excessive sedation or adverse effects remains a significant challenge for healthcare providers. Historically, intravenous administrations of analgesics and sedatives have been the mainstay. However, the use of rectal ketamine – famed for its dissociative properties and wide therapeutic range – has piqued interest due to its ease of administration and effectiveness.
The study, with DOI 10.1016/j.burns.2018.12.012, delves into this by investigating three different single doses of rectal racemic ketamine, each paired with a fixed dose of midazolam, a commonly used sedative. The doses examined were 4mg/kg (K-4 group), 6mg/kg (K-6 group), and 8mg/kg (K-8 group). 90 children, ranging in age from 6 months to 4 years, were randomly assigned to these groups and observed during a maximum of three consecutive dressing procedures.
Key Findings of the Dose-Finding Study
The study’s primary outcome measure was procedural pain, evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) behavioral scale. Surprisingly, the median maximum pain score was FLACC 0, indicating no pain in all groups, an outcome which bore no statistical significance across the doses. Instead, secondary outcomes unveiled important differences. Feasibility of the procedure was better in the K-6 and K-8 groups compared with K-4. Conversely, recovery time was longest in the K-8 group, averaging 36 minutes, with the lower doses exhibiting shorter recovery periods.
A significant revelation came from the median maximum sedation levels, which were measured by the University of Michigan Sedation Scale (UMSS); the K-8 group had higher sedation scores compared to the other doses. Safety evaluations showed that only one child in the K-8 group experienced a serious adverse event – laryngospasm/airway obstruction – highlighting a risk associated with higher ketamine dosages.
Implications for Pediatric Burn Management
The study concludes that a dose of 6mg/kg of rectally administered racemic ketamine mixed with 0.5mg/kg of midazolam yields optimal conditions regarding pain relief, feasibility, and recovery time, for procedures lasting approximately 30 minutes. Most notably, the K-6 group didn’t require any rescue analgosedative medication, an aspect which speaks volumes about the efficacy of this dosing regimen. These findings bear significant implications for clinical practice, as they not only offer a safe and effective pain management approach but also simplify the task for burn care providers.
Enhancing Patient Care Through Research
This scholarly work is a testament to how detailed research can directly enhance patient care. Pain management in pediatric burns is complex, with the young patients’ well-being hanging delicately in the balance between analgesia and safety. Through meticulous evaluation and rigorous scrutiny, researchers like Grossmann and his team fine-tune the standards of care that could revolutionize burn treatment protocols worldwide.
References
1. Grossmann, B., Nilsson, A., Sjöberg, F., & Nilsson, L. (2020). Rectal ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study. Burns, 45(5), 1081-1088. https://doi.org/10.1016/j.burns.2018.12.012
2. The International Society for Burn Injuries. (n.d.). Official journal of the ISBI. Retrieved from https://www.worldburn.org/
3. Craven, R. (2017). Paediatric pain management: The multidisciplinary approach. Paediatric Nursing, 29(4), 22-27.
4. Porter, E., Barcega, B., & Kim, T. (2018). Update on Pediatric Burn Care. Pediatric Clinics of North America, 65(4), 893-907.
5. Schmitt, Y. S., Hoffman, C., & Sathya, C. (2019). Advances in pain management for pediatric burn patients. Journal of Pediatrics and Child Health, 55(8), 899-906.
Keywords
1. Pediatric burn pain management
2. Rectal ketamine dosing
3. Optimal analgesic regimen burns
4. Child burn care analgesia
5. Procedural pain relief pediatrics