Vol. 7, Issue 2, Part B (2025)

Burn injuries produce some of the most severe and persistent forms of acute pain, often requiring multimodal analgesic strategies. Opioids have long been the cornerstone of acute burn pain management; however, their limitations such as tolerance, respiratory depression and opioid-induced hyperalgesia have prompted the search for alternative agents. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a promising alternative or adjunct due to its potent analgesic, antihyperalgesic and opioid-sparing effects. This systematic review aims to evaluate the comparative efficacy and safety of ketamine versus opioids alone in the management of acute burn pain. A systematic search was performed across PubMed, Scopus, MEDLINE, Cochrane Library and ScienceDirect for articles published between 2010 and 2024. Studies including randomized controlled trials, cohort studies and comparative observational studies evaluating ketamine and opioid-based analgesia in adult and pediatric burn patients were included. A total of 25 peer-reviewed studies were critically analysed for pain reduction efficacy, hemodynamic stability, opioid-sparing effect and adverse reactions. The review indicates that ketamine, either as monotherapy or as an adjunct to opioids, provides comparable or superior analgesia during burn wound dressing, debridement and early recovery phases. Ketamine significantly reduced total opioid consumption and the incidence of respiratory depression, nausea and vomiting. Although transient psychomimetic effects were observed in some cases, these were mild and manageable. Ketamine demonstrates high efficacy and favorable safety compared with opioids alone in acute burn pain management. Its inclusion in multimodal analgesic regimens can optimize patient comfort, reduce opioid dependence and enhance procedural tolerance. Further large-scale, standardized clinical trials are needed to confirm the ideal dose range and administration protocols for burn care settings.