U.S. Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA.
Pain Med. 2011 Apr;12(4):673-8. doi: 10.1111/j.1526-4637.2011.01091.x. Epub 2011 Apr 11.
US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extreme pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain. We describe the first use of ketamine combined with immersive VR to reduce excessive pain during wound care.
A 21-year-old male US Army soldier stationed in Iraq, and a 41-year-old civilian male sustained a 13% and 50% total body surface area (TBSA) burn, respectively. Each patient received 40 mg ketamine intraveneous (IV) for wound care. Using a within-subject design, nurses conducted half of a painful segment of wound care treatments with no VR and the other half with immersive VR. Graphic pain rating scores for each of the two treatment conditions served as the dependent variables.
Compared to ketamine + no VR, both patients reported less pain during ketamine + VR for all three pain ratings. Both patients rated wound care during no VR as "no fun at all", but those same patients rated wound care during virtual reality as either "pretty fun" or "extremely fun", and rated nausea as either "mild" or "none".
Results from these first two cases suggest that a moderate dose of ketamine combined with immersive virtual reality distraction may be an effective multimodal analgesic regimen for reducing acute procedural pain during severe burn wound cleaning.
在伊拉克受伤的美国士兵和民用烧伤创伤患者在美军外科研究所接受治疗。烧伤患者在伤口护理过程中会经历极度疼痛,他们通常会接受阿片类镇痛药和苯二氮䓬类药物进行清创。虚拟现实 (VR) 已被应用于阿片类镇痛药辅助治疗程序疼痛。我们描述了首次将氯胺酮与沉浸式 VR 结合用于减轻伤口护理过程中过度疼痛的情况。
一名 21 岁的美国陆军士兵驻扎在伊拉克,一名 41 岁的平民男子分别遭受了 13%和 50%的全身体表面积 (TBSA) 烧伤。每位患者均接受 40 毫克氯胺酮静脉注射 (IV) 进行伤口护理。采用自身对照设计,护士在无 VR 的情况下进行一半的疼痛段伤口护理治疗,另一半则进行沉浸式 VR 治疗。两种治疗情况下的图形疼痛评分作为因变量。
与氯胺酮+无 VR 相比,两名患者在接受氯胺酮+VR 治疗时,所有三种疼痛评分均报告疼痛减轻。两名患者均将无 VR 时的伤口护理评为“一点都不好玩”,但这些患者同样将 VR 时的伤口护理评为“相当有趣”或“非常有趣”,并将恶心评为“轻度”或“无”。
这两例的结果表明,中等剂量的氯胺酮与沉浸式虚拟现实分散注意力相结合,可能是一种有效的多模式镇痛方案,可减轻严重烧伤伤口清洁过程中的急性程序疼痛。