Combining ketamine and virtual reality pain control during severe burn wound care: one military and one civilian patient

Abstract

Background: 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.

Case report: 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.

Results: 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".

Conclusions: 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.

Wiley Periodicals, Inc.

Figures

Figure 1

US Army soldier receiving immersive virtual reality (VR) to reduce his pain during severe burn wound care. The unique robot-like arm mounted VR goggles designed by Hoffman and built by Jeff Magula at the University of Washington, Seattle, holds the VR goggles near the patient’s eyes weightlessly, reducing the amount of surface contact (if any) needed with the patient. Photo and copyright Hunter Hoffman.

Figure 2

SnowWorld. A screenshot of what patients see in the goggles during immersive virtual reality pain distraction. World designed/developed by Hoffman and Patterson, University of Washington, Seattle, and software created by world builders at Firsthand. Image captured by Firsthand Technologies, copyright Hunter Hoffman.

Figure 3

Patient 1 pain ratings. Compared with ketamine + no virtual reality (VR) (shown in dark gray), patient 1 reported large reductions in pain unpleasantness during ketamine + immersive VR (shown in light gray) during severe burn wound care of burn injury.

Figure 4

Patient 2 pain ratings. Patient 2 reported large reductions in pain during virtual reality (VR) (shown in light gray) compared with no VR (shown in dark gray) during burn wound care of a severe burn injury resulting from a house fire during Hurricane Ike.