UCSF

Acutely and critically ill patients are exposed to many therapeutic procedures that can produce painful experiences. Tracheal suctioning (TS) and wound care procedure (WCP) are frequently performed in these patients. The purpose of this dissertation was to evaluate pain responses during both TS and WCP and to determine the efficacy of a pharmacologic treatment to prevent pain during an open WCP.

The first report was a secondary data analysis of findings from a larger procedural pain study. A total of 755 patients underwent the TS procedure that was performed primarily in intensive care units (93%). Pain intensity mean (SD) scores were significantly greater during the TS procedure 3.96 (3.3) than prior to 2.14 (2.8) or after 1.98 (2.7). Few patients received analgesics prior to or during the procedure. Although mean pain intensity during TS was mild, almost the half of the patients who presented pain reported it as moderate to severe.

The second study was a randomized, cross-over design with the purpose to determine whether the addition of small doses of ketamine would potentiate morphine's analgesic effects and decrease WCP pain intensity. Patients were randomized to receive morphine plus saline (MS) IV or morphine plus ketamine (MK) IV before the WCP. When the WCP was repeated, patients were crossed-over to receive the alternate treatment.

Eleven patients from the Trauma Hospital of Puerto Rico participated in the study. Procedural pain intensity mean ranks during the WCP-MK was significantly less than during the WCP-MS (p = .005). Mean (SD) procedural pain intensity during the WCP-MK was 3.09 (3.27), while it was 6.82 (3.06) during the WCP-MS. However, 91% of patients had adverse effects during MK versus none during MS. In addition, mean (SD) diastolic BP was significantly higher during the WCP-MK than during WCP-MS and prior to WCP-MK, 84 (11.8), 73 (7.4), 72 (12.6), respectively.

Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as TS and WC. Further research is warranted to determine the dose of ketamine that is analgesic but causes minimal adverse effects during a WCP.