Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Institute of National Importance, Pondicherry 605 006, India.
Burns. 2013 Sep;39(6):1150-6. doi: 10.1016/j.burns.2013.02.012. Epub 2013 Apr 25.
Study was designed to compare analgesic efficacy and side effects of oral dexmedetomidine and ketamine in adults for burn wound dressing. Sixty healthy adults with thermal burns with burn area (20-50%) were randomly assigned into 2 groups. In Group K 5mg/kg ketamine and in Group D 4 mcg/kg dexmedetomidine was given orally. Patients crossed over to the other group the following day. Visual analogue score, sedation score, haemodynamic parameters were recorded from 30min after drug administration to 2h after procedure. Patients' preference was also recorded. Mean VAS score was significantly reduced from baseline in both the groups at all time points (P<0.05). Pain relief in Group K (overall mean VAS 2.6±0.6cm) was significantly better when compared to Group D (overall mean VAS 3.8±0.8cm). Patients in group K were significantly more sedated (median 3) when compared to group D (median 2), P<0.05. Delirium and excessive salivation were significant complications observed with ketamine. More patients preferred ketamine (63.3%) than dexmedetomidine (36.7%), P<0.05. Oral ketamine and dexmedetomidine produced significant pain relief during burns wound dressing. Oral ketamine produced significantly better pain relief than dexmedetomidine but was associated with delirium and excessive salivation.
本研究旨在比较口服右美托咪定和氯胺酮在成人烧伤创面敷料中的镇痛效果和副作用。60 例成人热烧伤面积（20-50%）患者随机分为 2 组。在 K 组中给予 5mg/kg 氯胺酮，在 D 组中给予 4 mcg/kg 右美托咪定。患者第二天交叉到另一组。从用药后 30 分钟到 2 小时，记录视觉模拟评分、镇静评分、血流动力学参数。还记录了患者的偏好。两组患者在所有时间点的 VAS 评分均较基线显著降低（P<0.05）。与 D 组（总体平均 VAS 3.8±0.8cm）相比，K 组（总体平均 VAS 2.6±0.6cm）的疼痛缓解明显更好。与 D 组（中位数 2）相比，K 组患者镇静程度明显更高（中位数 3），P<0.05。氯胺酮观察到谵妄和过度流涎是显著的并发症。与右美托咪定（36.7%）相比，更多患者更喜欢氯胺酮（63.3%），P<0.05。口服氯胺酮和右美托咪定在烧伤创面敷料时均可显著缓解疼痛。口服氯胺酮比右美托咪定能显著更好地缓解疼痛，但与谵妄和过度流涎有关。
