Abstract
Study objective
Compare adverse effects and analgesic efficacy of low-dose ketamine for acute pain
in the ED administered either by single intravenous push (IVP) or short infusion (SI).
Methods
Patients 18–65, presenting to ED with acute abdominal, flank, or musculoskeletal pain
with initial pain score ≥ 5, were randomized to ketamine 0.3 mg/kg by either IVP or SI with placebo double-dummy. Adverse effects were evaluated
by Side Effects Rating Scale for Dissociative Anesthetics (SERSDA) and Richmond Agitation-Sedation
Scale (RASS) at 5, 15, 30, 60, 90, and 120 min post-administration; analgesic efficacy was evaluated by Numerical Rating Scale
(NRS).
Results
48 patients enrolled in the study. IVP group had higher overall rates of feeling of
unreality on SERSDA scale: 92% versus 54% (difference 37.5%; p = 0.008; 95% CI 9.3–59.5%). At 5 min median severity of feeling of unreality was 3.0 for IVP versus 0.0 for SI (p = 0.001). IVP also showed greater rates of sedation on RASS scale at 5 min: median RASS −2.0 versus 0.0 (p = 0.01). Decrease in mean pain scores from baseline to 15 min was similar across groups: 5.2 ± 3.53 (95% CI 3.7–6.7) for IVP; 5.75 ± 3.48 (95% CI 4.3–7.2) for SI. There were no statistically significant differences
with respect to changes in vital signs and need for rescue medication.
Conclusion
Low-dose ketamine given as a short infusion is associated with significantly lower
rates of feeling of unreality and sedation with no difference in analgesic efficacy
in comparison to intravenous push.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ketamine use in current clinical practice.Acta Pharmacol Sin. 2016; 37: 865-872
- Intravenous sub-anesthetic ketamine for perioperative analgesia.J Anaesthesiol Clin Pharmacol. 2016; 32: 160-167
- Ketamine: current applications in anesthesia, pain, and critical care.Anesth Essays Res. 2014; 8: 283-289
- The effect of combined treatment with morphine sulphate and low-dose ketamine in a prehospital setting.Scand J Trauma Resusc Emerg Med. 2009; 17: 61
- Management of severe acute pain in emergency settings: ketamine reduces morphine consumption.Am J Emerg Med. 2007;May; 25: 385-390
- Effective analgesia with low-dose ketamine and reduced dose hydromorphone in ED patients with severe pain.Am J Emerg Med. 2013; 31: 847-851
- Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial.Acad Emerg Med. 2014; 21: 1193-1202
- Intravenous sub-dissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial.Ann Emerg Med. 2015; 22: 251-257
- (Statement) (Accessed on 9/25/16)
- Continuous subcutaneous administration of the N-methyl-d-aspartic acid (NMDA) receptor antagonist ketamine in the treatment of post-herpetic neuralgia.Pain. 1995; 61: 221-228
- Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).JAMA. 2003; 289: 2983-2991
- An introduction to the bootstrap.Chapman & Hall/CRC, Boca Raton, FL1998
- Intranasal ketamine for analgesia in the emergency department: a prospective observational series.Acad Emerg Med. 2013; 20: 1050-1054
- Short (low-dose) ketamine infusion for managing acute pain in the ED: case-report series.Am J Emerg Med. 2015; 33: 601.e5-7
- Low-dose ketamine infusion for emergency department patients with severe pain.Pain Med. 2015; 16: 1402-1409
Article Info
Publication History
Published online: March 03, 2017
Accepted:
March 2,
2017
Received in revised form:
March 1,
2017
Received:
February 21,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
