Oral ketamine adjunct for wound care in patients with burn injuries

Opioids and benzodiazepines provide the foundation for procedural sedation during wound care following burn injury. Ketamine has been used as an adjunct and may limit exposure to opioids. Few data are published describing the use of oral ketamine in this population. This study was performed to compare the effects of oral ketamine on opioid and benzodiazepine requirements during wound care following burn injury. This was a retrospective, single center cohort study (August 2022-2024). The electronic medical record was queried for adult (≥18 years) patients admitted to the burn intensive care unit who received oral ketamine as a premedication for wound care. The primary outcome was oral morphine equivalents (OMEs) before (pre) and after (post) initiation of oral ketamine. Only medications used during wound care were recorded. Descriptive statistics were utilized for analysis. A total of 52 patients were included. The median percent total body surface area (%TBSA) burned was 31 (IQR 20-48). The median ketamine dose received during wound care was 100 mg (IQR 100-125). All patients received IV fentanyl and 47 (90%) received IV midazolam. Patients received a median of 225 mg (IQR 150-300) vs 180 mg (IQR 120-240) (P=0.008) of OMEs in the pre- and post-groups, respectively. There was no difference in midazolam received (6 mg [IQR 4-8] vs 5 mg [IQR 3-8]; P = 0.21). Oral ketamine may be an effective adjunct to wound care following burn injury and may reduce exposure to opioids.