A systematic review of ketamine as an analgesic agent in adult burn injuries

Objective. To assess the current literature regarding the effectiveness and side-effect profile of intravenous ketamine as a means of pain relief when compared with placebo or as an adjunct to opioid analgesia in patients exposed to burn injury. Design. Electronic searches of MEDLINE, CINAHL, Embase, and The Cochrane Library databases from 1966 onward were used to identify clinical trials comparing ketamine with placebo in the adult burn population. Outcomes Measured. Effectiveness and side-effect profile of ketamine as an analgesic agent in burn injuries. Results. Four experimental trials involving 67 patients were identified. Due to heterogeneity of studies, pooling of the results and meta-analysis were not possible. Intravenous ketamine showed some efficacy as an analgesic for burn injuries, with a reduction in secondary hyperalgesia when compared with opioid analgesia alone. Combination therapy of ketamine and morphine resulted in the abolishment of windup pain phenomena. The side-effect profile did not result in the withdrawal of any participants included in the studies results. Conclusions. Further well-designed randomized controlled trials conducted in burn-specific populations are warranted, thus enabling the development of a relevant evidence base to support its clinical use. Wiley Periodicals, Inc.