Ultra rapid opioid detoxification in major burn patients: proof of feasibility study in a military population

Chronic pain management for major burn patients may pose a challenge for even the most experienced clinician as there is a constant struggle between creation of opioid treatment plans and the development of opioid tolerance due to this chronic therapy. Dr. P. Desocio and his co-workers at Fort Sam Houston (USA) have therefore designed a study to perform ultra rapid opioid detoxification (UROD) in severely burned service members using dexmedetomidine, ketamine and naloxone to reduce narcotic requirements of these patients by fifty percent.

Minimizing opioids in burn patients is often hampered by the fact that the patients have to undergo multiple surgeries and painful long-term rehabilitation treatment programs. Furthermore, baseline pain unresponsive to non-opioid pain medication adjuncts makes it difficult to establish non-opioid treatment plans.

Pre-treatment of study patients includes aspiration prophylaxis and clonidine to suppress withdrawal systems. After intubation, maintenance dexmedetomidine infusion is initiated to attenuate cardiostimulatory effects during opioid antagonist administration and to provide sedation during mechanical ventilation.

Dr. Desocio et al. point out that this military population based study may demonstrate higher success rates and minimal relapse in comparison to civilian opioid detoxification programs because service members treated in military medical facilities have favourable risk to benefit ratios due to their access to medical specialists free of any direct financial cost and due to the fact that they often profit from a close-knit social support network. Results of this study may provide the basis for prospective observational UROD studies and may facilitate inclusion of UROD into civilian insurance coverage once they have proved successful in military patients.