Highlights
- •Procedural sedation and analgesia using ketamine have been widely used in emergency department settings during wound repair
- •However, all of these protocols emphasize only the effectiveness and efficacy of ketamine, without mention of the need for local anesthesia.
- •There was no difference in pain and sedation scales between the groups treated with or without local anesthesia and, local anesthesia was not needed
Abstract
Purpose
The objective of this study was to evaluate whether sedation with ketamine without
local anesthesia was sufficient in children undergoing primary repair.
Methods
Randomized, double-blind trial conducted between December 2013 and October 2016 in
a tertiary care pediatric emergency department in Korea. Children aged 1 to 10 years
requiring sedation for primary repair were randomly assigned to receive local lidocaine
anesthesia with ketamine sedation or local saline injection with ketamine sedation.
Children's Hospital of Eastern Ontario Pain Scale scores was recorded during the procedures.
The pain scales were recorded by nurses who were blinded to the study drugs, before
ketamine sedation, after sedation, during the first injection of the study drugs for
wound repair, during the first stitch, and after the procedure.
Results
Twenty-five were randomized to receive ketamine sedation with local anesthesia and
twenty-two to receive ketamine sedation without local anesthesia. There was no significant
difference in pain scale before ketamine sedation (difference (mean): −1.11, CI: −2.78-0.55,
P value: 0.18), after sedation (difference (mean): −0.60, CI: −2.20-1.01, P = 0.46),
during the first injection of the study drugs for wound repair (difference (mean):
−0.03, CI: −0.31-0.25, P = 0.84), during the first stitch (difference (mean): −0.15,
CI: 6.19–6.79, P = 0.62), during the primary repair (difference (mean): 0.20, CI:
−55-0.95, P = 0.59), and after the procedure (difference (mean): 0.17, CI: −0.48-0.82,
P = 0.59).
Conclusion
Sedating with ketamine for primary wound repair, there was no difference in pain and
sedation scales between the patients treated with or without lidocaine local anesthesia,
and local anesthesia was not needed.
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Article Info
Publication History
Published online: March 19, 2020
Accepted:
March 16,
2020
Received in revised form:
March 11,
2020
Received:
February 18,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Inc. All rights reserved.
